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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425800215
Report Date: 04/26/2023
Date Signed: 04/26/2023 01:19:19 PM

Document Has Been Signed on 04/26/2023 01:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:MCMILLAN RANCHFACILITY NUMBER:
425800215
ADMINISTRATOR:MARTHA MANCHAFACILITY TYPE:
735
ADDRESS:3840 ORCUTT GAREY ROADTELEPHONE:
(805) 937-2826
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 10CENSUS: 8DATE:
04/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Martha Mancha, AdministratorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Olson conducted an unannounced annual visit to this facility. LPA arrived at the facility and contacted the Administrator, Martha Mancha. Administrator came to the facility around 10:05 AM. This facility sustained flood damage during a storm in January 2023 and is currently under construction. LPA toured the inside and outside of the facility with Administrator from 10:05-10:40pm. LPA and Administrator went over the CARE Tool from 10:45-11:45AM.

The backyard has a covered outdoor area equipped with furniture for client use. No bodies of water noted. The washer and dryer are in the garage. The garage is not locked.

LPA conducted a visit to the hotel the clients have been staying at during the construction. LPA observed 8 clients, 2 staff and Administrator at the hotel. LPA conducted interviews with staff and clients from 12:10-1pm. Clients indicated everything was going well and their needs are met.



Medications: LPA observed Medications to be locked in the hotel closet in the staff's room. Medications are centrally stored and usually locked in a cabinet in the facility office.

Infection Control: The facility has an infection control plan. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19.

Administrator indicated they should be able to move back into the facility May 10, 2023. LPA will return at another date to continue the annual inspection.



Exit interview conducted, a copy for the report given.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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