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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801423
Report Date: 10/10/2024
Date Signed: 10/10/2024 03:26:18 PM

Document Has Been Signed on 10/10/2024 03:26 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:HOUSE OF TRANSITIONFACILITY NUMBER:
565801423
ADMINISTRATOR/
DIRECTOR:		JESUS CARDENAS AMADORFACILITY TYPE:
772
ADDRESS:1750C SOUTH LEWIS ROADTELEPHONE:
(805) 437-2903
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY: 15CENSUS: 13DATE:
10/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Isabelle Blecher / Steven TorresTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Martha Arroyo conducted a required annual inspection today at 10:30am. Upon arrival, LPA met with staff and the reason for the visit was explained. The Residential Program Manager, Isabelle Blecher arrived during the inspection. Entrance interview conducted.

At 10:40am, the LPA along with 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 facility is equipped with two (2) separate kitchens; one (1) kitchen for staff use; and, second kitchen for client use. Kitchens were equipped with fixtures and appliances that appeared clean and functional. Knives and sharps are stored in a locked drawer inaccessible to clients. There was an adequate supply of perishable and nonperishable food.

BEDROOMS: There were 15 bedrooms designated for client use. Client bedrooms were observed to be designated for single occupancy and were properly furnished, including adequate supplies of bedding and linen, with sufficient lighting.

BATHROOMS: Each client bedrooms includes an individual half bathroom. All bathrooms observed were properly supplied with paper products and personal hygiene items and fixtures were observed to be functional at the time of the visit. LPA observed two (2) out of four (4) showers to be out of service at the time of the inspection. Staff stated that a work order is in the system pending to be completed.

Report Continued on LIC 809C...
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: HOUSE OF TRANSITION
FACILITY NUMBER: 565801423
VISIT DATE: 10/10/2024
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Report Continued from LIC 809...

Starting at 10:50am, the hot water temperature was measured in various bathrooms throughout the facility, and they measured between 113.1 degrees Fahrenheit and 117.3 degrees Fahrenheit.

COMMON AREAS: Common areas include two (2) living room and one (1) dining room. All common areas were adequately furnished for client use. There is also a laundry room, which clients utilize. Staff provide cleaning detergent upon request. All hazardous cleaning chemicals were observed to be stored, locked, and inaccessible to clients at the time of the visit. There is a working telephone on premises. Activities for clients were observed in the dining room and living room areas.

SURROUNDING GROUNDS: There are several shaded areas with adequate furniture for client use.

MEDICATIONS: At approximately 12:20pm a medications review of randomly selected clients was conducted. Medication are stored inside the medication room by the main entrance. All medications including PRNs were labeled, stored, and locked inaccessible to clients in care. All medications reviewed were stored and documented per regulation.

RECORD REVIEW: LPA reviewed Client Records at 11:14am and Personnel Records at 12:56pm.

Six (6) client files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, and current needs and services plan. All records were in order.

Four (4) personnel files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Staff files were complete.

Report Continued on LIC 809C...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: HOUSE OF TRANSITION
FACILITY NUMBER: 565801423
VISIT DATE: 10/10/2024
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Report Continued from LIC 809C...

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and recently reviewed/updated. Fire extinguisher were observed throughout the facility fully charged with a date of 11/09/2023. Emergency disaster drills are conducted quarterly, with the last one conducted on 09/20/2024.

No citations issued. Exit interview conducted. Report was reviewed and copy issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
LIC809 (FAS) - (06/04)
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