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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800394
Report Date: 02/09/2024
Date Signed: 02/09/2024 04:53:22 PM

Document Has Been Signed on 02/09/2024 04:53 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
WOODLAND HILLS N.ASC, 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: 8DATE:
02/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Bettina BrownTIME COMPLETED:
05:00 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
At 01:50 p.m. Licensing Program Analysts (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. LPA met with Licensee Bettina Brown and explained the reason for the visit

At 01:58 p.m., the LPA conducted a tour of the physical plant with Licensee Bettina Brown to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a double-story residence that consists of five (5) client bedrooms, one (1) office, two (2) staff rooms, three (3) client bathrooms and one (1) staff bathroom. The LPA observed fire extinguishers at the facility, which were fully charged and last serviced 01/29/2024.

KITCHEN The facility has a sufficient supply of perishable and non-perishable food. Knives and items that could pose a danger are stored in a locked closet inside the office. The LPA observed missing tile in the kitchen wall, missing handle on a broken kitchen drawer. The LPA observed the ceiling fan in the kitchen covered in debris. Upon observation, Licensee stated the Facility will be starting to go under renovations in March 2024 which will include renovations in the following areas: kitchen, 2 new bathrooms, laundry room, ceiling upgrade, all flooring and inside/outside painting.

COMMON SPACES/OUTDOORS: These included the living, dining area and backyard. The living room area and dining room area has sufficient seating for the residents and was free of obstruction. The washer and dryer are in the laundry. The Licensee was experiencing a current water leak from the washer machine that was fixed during the visit. Cleaning supplies are locked in a closet. The backyard has a covered outdoor area equipped with furniture for resident use.

Report will continue on LIC809-C.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2024
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: BROWN BOARD & CARE
FACILITY NUMBER: 565800394
VISIT DATE: 02/09/2024
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
26
27
28
29
30
31
32
BEDROOMS: The LPA observed the client bedrooms, all bedrooms and common areas are in need of vacuuming as debris was observed on the floor. All rooms had sufficient lighting. The carpet throughout the facility had rips and stains. Smoke alarms and carbon monoxide detectors were tested. The LPA could not verify the smoke detector in the office to be operable as the button to test the detector broke as the administrator pressed it. The LPA observed one (1) staff room without a smoke detector. Smoke detectors were placed in the office and staff room during todays visit. All smoke alarms were observed to be in operable condition. The LPA observed all three staff rooms unlocked. At 2:35 p.m. the LPA observed ibuprofen medication, and a bottle of BAYER aspirin in one (1) unlocked staff room accessible to residents in care.

RESTROOMS: There are three restrooms for client use and one staff restroom. At 02:43 p.m. the hot water temperature in the downstairs restroom measured at 120.6 degrees F. The restrooms were found to be in operating condition with hand soap and paper towels. The LPA had a conversation with the Licensee of best practices to ensure water temperature does not go over 120 degrees F.

Record Review/Med Audit: At 3:50 p.m., a review of facility files was initiated. Facility records are stored in the facility office. The LPA observed documentation of Infection Control, Disaster prevention and last fire drill (conducted on 10/03/2023). The LPA obtained Client Roster, Staff Roster, and facility Sketch. The LPA reviewed one (1) of eight (8) client Files and medications. Records and medication for the client reviewed was complete and current.

Due to time constraints the LPA will return at a later date to complete the annual.



Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 02/09/2024 04:53 PM - It Cannot Be Edited


Created By: Esther Cortez On 02/09/2024 at 04:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: BROWN BOARD & CARE
FACILITY NUMBER: 565800394

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above as the LPA observed medication in an unlocked staff room accessible to clients in care which poses an immediate health and safety risk to persons in care.
POC Due Date: 02/09/2024
Plan of Correction
1
2
3
4
Plan of correction has been met, all staff rooms and office were locked during todays visit.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kasandra Lopez
LICENSING EVALUATOR NAME:Esther Cortez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2024


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 02/09/2024 04:53 PM - It Cannot Be Edited


Created By: Esther Cortez On 02/09/2024 at 04:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: BROWN BOARD & CARE
FACILITY NUMBER: 565800394

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above as the common areas and bedrooms are in need of vacuuming and the kitchen ceiling is in need of cleaning which posed a potential health and safety risk to persons in care.
POC Due Date: 02/12/2024
Plan of Correction
1
2
3
4
Licensee agreed that they will submit proof vacuuming throughout the facility has been completed and the kitchen ceiling fan has been cleaned by 2/12/24.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kasandra Lopez
LICENSING EVALUATOR NAME:Esther Cortez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4