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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800394
Report Date: 02/17/2022
Date Signed: 02/25/2022 02:18:58 PM

Document Has Been Signed on 02/25/2022 02:18 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:BROWN BOARD & CAREFACILITY NUMBER:
565800394
ADMINISTRATOR:BETTINA BROWNFACILITY TYPE:
735
ADDRESS:1337 W. HILL STREETTELEPHONE:
(805) 483-9618
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 10CENSUS: 9DATE:
02/17/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Bettina BrownTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Required 1 Year Inspection at the facility. Due to computer issues, the LPA was unable to select Required 1 Year as the visit type. The LPA met caregiver Ray King and explained the reason for the inspection. Administrator Bettina Brown arrived at the facility at 1:14 PM.

The LPA, along the caregiver, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:
Common Areas: The living room area and dining room area has sufficient seating for the residents and was free of obstruction. The carbon monoxide detector and smoke alarms in the common areas and bedrooms were tested and operational. The fire extinguishers were observed be charged but last serviced on 01/05/2022. The washer and dryer are in the laundry and were observed to be functioning. Cleaning supplies are locked in a closet. The backyard has a covered outdoor area equipped with furniture for resident use. Medications are locked and centrally stored in the closet in the office. Kitchen: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food stored. There are two refrigerators that store food for resident use. Common Restrooms: There are three restrooms for resident use. At 12:58 PM, the hot water temperature in the upstairs restroom measured at 117.1 degrees F. The restrooms were found to be clean and sanitary and operating condition with hand soap and paper towels. Infection Control: During today’s visit, the LPA spoke with the caregiver regarding the facility’s infection control practices. The facility’s cleaning protocol is sufficient. Upon entry, the facility has a central entry point for symptom screening. LPA observed staff to be wearing a mask. The LPA observed an adequate supply of Personal Protective Equipment (PPE). If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate.

No deficiencies were observed during today's inspection. A copy of the report will be emailed.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2022
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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