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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801393
Report Date: 08/19/2022
Date Signed: 08/19/2022 04:04:10 PM

Document Has Been Signed on 08/19/2022 04:04 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:GONZALES FAMILY HOMEFACILITY NUMBER:
565801393
ADMINISTRATOR:VENIE G. GONZALESFACILITY TYPE:
735
ADDRESS:4450 BROWNING DRIVETELEPHONE:
(805) 488-2315
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 6CENSUS: 5DATE:
08/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Leonardo TugadeTIME COMPLETED:
03:15 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
Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Required - 1 Year Annual
inspection at the facility today. The Administrator Venie Gonzales was contacted at 2:26 PM and advised of the inspection. The Administrator gave permission for staff to sign today's report.
This annual had a specific emphasis on infection control practices and procedures. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The carbon monoxide detector and smoke alarms were tested and all functioned properly. The fire extinguisher was last serviced on 07/06/2022.
KITCHEN: Knives and and items that could pose a danger are in a locked cabinet. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Medications are stored in a locked cabinet in the dining room area.
BEDROOMS: The LPA observed four single occupancy client bedrooms and one shared client bedroom
which were furnished appropriately with clean linens and sufficient lighting.
RESTROOMS: There is one common restroom for client use which was clean and sanitary and in operating
condition with hand soap, paper towels, and toilet paper. The hot water measured at 105.8 degrees F. There is also a private restroom in the shared bedroom.
COMMON SPACES: Living room and dining room furniture was observed to be in good condition. The LPA
observed the required postings upon entry. The backyard patio is equipped with furniture for clients' use.
INFECTION CONTROL: During today’s visit, the LPA reviewed the facility’s infection control practices with staff. Upon entry, the facility has a central entry point for symptom screening and sanitation station. All facility staff were observed wearing masks. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility has appropriate plans in place in the event of clients and/or staff are showing symptoms of COVID or testing positive for COVID. No deficiencies observed.
Exit interview conducted with staff. Report emailed to Administrator.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2022
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