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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561703412
Report Date: 09/09/2022
Date Signed: 09/09/2022 10:58:03 AM

Document Has Been Signed on 09/09/2022 10:58 AM - 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:CUDAL BOARD AND CARE HOMESFACILITY NUMBER:
561703412
ADMINISTRATOR:PERFECTO P. CUDALFACILITY TYPE:
735
ADDRESS:1930 ONTARIO STREETTELEPHONE:
(805) 985-5646
CITY:OXNARDSTATE: CAZIP CODE:
93035
CAPACITY: 6CENSUS: 5DATE:
09/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Perfecto P. Cudal, Licensee TIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced required annual visit. At 10:00 a.m., the LPA met with the Licensee, Perfecto P. Cudal and explained the reason for the visit. This annual had a specific emphasis on infection control practices and procedures.

At 10:20 a.m., the LPA, along with the Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations.

COMMON SPACES: All indoor and outdoor passages were free of obstruction. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the fire extinguisher to be fully charged and last serviced on 08/16/2022. Signs are posted throughout facility to promote handwashing, and cough/sneeze etiquette. At 10:28 a.m., fire alarms/carbon monoxide detectors were tested and functioning properly.

BEDROOMS: There are a total of five (5) bedrooms, three (3) for client use and two (2) for staff use. The LPA observed the client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Medications are centrally stored and in a locked cabinet in one of the staff rooms.

RESTROOMS: Restrooms were observed to be clean and sanitary with hand soap, toilet paper and paper towels. At 10:21 a.m., the hot water temperature tested at 105.1-degree Fahrenheit.

KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:23 a.m., hot water measured at 107.0-degree Fahrenheit.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CUDAL BOARD AND CARE HOMES
FACILITY NUMBER: 561703412
VISIT DATE: 09/09/2022
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OUTDOOR SPACE: At 10:25 a.m., the LPA observed the back patio which has a covered outdoor area for client use. There is a self-latching gate designated for an emergency exit.

GARAGE: The garage is attached to the house. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the garage. The laundry units are located inside the garage.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Licensee regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. The LPA observed a 30-day supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s policies and procedures as it pertains to infection control are adequate.

At 10:15 a.m., the LPA conducted Infection Control mitigation module with the Licensee.

No deficiencies were observed at this time. Exit interview conducted with the Licensee. Report issued and a copy of the report will be provided via email.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC809 (FAS) - (06/04)
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