565801260-6-29-2024-29-AS-ECOZ-D6PVB6-20240629161702

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801260
Report Date: 06/29/2024
Date Signed: 06/29/2024 04:17:23 PM

Document Has Been Signed on 06/29/2024 04:17 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:	TON-TON FAMILY HOME		FACILITY NUMBER:	565801260
ADMINISTRATOR/ DIRECTOR:	JOSE ONG		FACILITY TYPE:	735
ADDRESS:	841 BORREGO WAY		TELEPHONE:	(805) 488-8842
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY: 6		CENSUS: 5	DATE:	06/29/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:30 PM
MET WITH:	Maria Miranda		TIME VISIT/ INSPECTION COMPLETED:	04:20 PM

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At 02:30 p.m. Licensing Program Analysts (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. When the LPA arrived, there were two (2) staff and three (3) clients present. The LPA was greeted by Direct care staff Janette Quilao and informed them of the reason for the visit. Administrator Maria Miranda arrived shortly after.

The LPA, along with the care staff, 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:

KITCHEN: The kitchen and food storage areas were observed. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food stored. Items that could pose a danger including sharp items and cleaning supplies were secured in locked drawers. Facility has a three day supply of emergency food and water. Medications are stored in a locked drawer in the kitchen.

COMMON SPACES: In the common areas, furniture, walls, and flooring were clean and in good condition at the time of the inspection. All indoor and outdoor passages were free of obstruction. The fire extinguisher was fully charged and last serviced on 01/18/2024. At 2:41 PM, the carbon monoxide detector and smoke detectors in the common areas and bedrooms were tested and were operational. The backyard has outdoor seating with a shaded area for client use. The garage is always locked and used for storage. There are no bodies of water on the premises

RESTROOMS: The facility has two common restroom for client use. Restrooms were observed to be clean and sanitary with hand soap, toilet paper and paper towels. The hot water temperature was measured in the hallway common restroom and it measured at 105.4 degree F.

The report will continue on LIC809-C.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2024

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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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: TON-TON FAMILY HOME	FACILITY NUMBER: 565801260
	VISIT DATE: 06/29/2024

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BEDROOMS: There are three client bedrooms and one staff bedroom. The LPA observed the client bedrooms to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

RECORDS: At 2:54 PM a review of facility files was initiated. Facility records are stored in a locked cabinet in the living room. The LPA observed documentation of Infection Control, Disaster prevention and last fire drill (conducted on 06/25/2024). The LPA reviewed five (5) staff Files and (5) of five (5) client files. All documents reviewed appeared complete and current. P&I money records for two (2) clients were reviewed. Cash resources were separate and intact, and not be commingled with facility funds or petty cash.

MEDICATIONS: Medications are locked and centrally stored in the kitchen. At 03:35 PM medications for two clients were reviewed. All medications are labeled and maintained in compliance with label instructions, and state and federal law. All medications reviewed were recorded on the centrally stored medication and destruction record. The LPA inspected the first aid kit, which was complete.

INTERVIEWS: LPA conducted two (2) and one (1) staff interviews. No immediate concerns were voiced.

No deficiencies were cited during today's inspection. A copy of the report was provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2024

LIC809 (FAS) - (06/04)

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