<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561703776
Report Date: 08/29/2022
Date Signed: 08/30/2022 11:31:50 AM

Document Has Been Signed on 08/30/2022 11:31 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:BARNARD FAMILY HOMEFACILITY NUMBER:
561703776
ADMINISTRATOR:KARLA IBARRAFACILITY TYPE:
735
ADDRESS:4780 BARNARD STREETTELEPHONE:
(805) 526-0043
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 6CENSUS: 5DATE:
08/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:42 AM
MET WITH:Karla IbarraTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
A required annual visit was conducted today, which has an emphasis on infection control practices and procedures. Upon arrival Licensing Program Analyst (LPA) met with staff. Staff contacted Administrator and reason for visit explained was explained.

INFECTION CONTROL: Today, the LPA spoke with staff and the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. This facility has records of staff and resident vaccinations. Staff are up to date regarding guidelines pertaining to visitation and vaccine requirements. The facility’s policies and procedures pertaining to infection control were adequate.

LPA and staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and community is in compliance with Title 22 Regulations. KITCHEN: Knives and sharp objects are stored in a locked cabinet in the kitchen. Cleaning supplies are stored locked and inaccessible to residents. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: Resident bedrooms observed furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: Restrooms observed clean and sanitary and in operating condition with grab bars and non-skid surfaces. Bathrooms were fully stocked with soap and paper towels. Appropriate hand-washing signs were observed in all bathrooms. COMMON SPACES:COVID-19 signage observed that promoted hand hygiene, physical distancing, and cough/sneeze etiquette. At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is inoperable. The LPA observed the required licensing postings listed throughout the facility. The backyard has a covered outdoor patio; side gate door is self-latching. There were no bodies of water noted. Additional perishable food was observed in the outside refrigerator. Facility is stocked with sufficient Personal Protection Equipment (PPE). Exit interview conducted. Email Administrator copy of report.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2022
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 1