565801896-12-20-2024-29-AS-KDUK-DC5TML-20241220135119

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801896
Report Date: 12/20/2024
Date Signed: 12/20/2024 01:51:46 PM

Document Has Been Signed on 12/20/2024 01:51 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:	LAND OF ENCHANTMENT BOARD AND CARE		FACILITY NUMBER:	565801896
ADMINISTRATOR/ DIRECTOR:	ROXANA LARA		FACILITY TYPE:	740
ADDRESS:	346 E. GAINSBOROUGH ROAD		TELEPHONE:	(805) 379-2185
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 6	DATE:	12/20/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:37 AM
MET WITH:	Roxana Lara		TIME VISIT/ INSPECTION COMPLETED:	01:55 PM

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Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 09:37AM. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Roxana Lara arrived at 10:00AM.

The LPA and the facility staff began the tour at 09:50AM, Administrator joined during the tour. LPA 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:

BEDROOMS/BATHROOMS: The facility contains 5 (five) resident bedrooms; 4 (four) are private resident rooms and 1 (one) is designated for shared use. Bedrooms were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. The 3 (three) resident bathrooms were clean, sanitary and in operating condition with grab bars and non-slip surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature was measured in resident bathrooms, and was within the required range.

KITCHEN: The LPA toured the kitchen/food service area. Knives and cleaning supplies are stored locked and inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Food was observed to be of good quality.

COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature throughout the visit. Hardwired combination smoke and carbon monoxide detectors and fire door were tested at 12:35PM and were operational at the time of the visit. Fire extinguisher was fully charged, and last purchased 04/24/2024. The LPA observed required postings throughout the common space. Auditory alarms on exit doors were observed to be functional at the time of the visit.

Continued on LIC 809-C

Kristin Heffernan	TELEPHONE: (818) 596-4493
Kelly Dulek	TELEPHONE: (951) 836-3170
	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LAND OF ENCHANTMENT BOARD AND CARE	FACILITY NUMBER: 565801896
	VISIT DATE: 12/20/2024

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OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for resident use. There is a side gate for emergency exit, resident use and is single latched. There is gated pool in the backyard that was locked and inaccessible at the time of the visit. Exits are free of obstructions. The garage is attached to the facility and access is through the kitchen. The washer and dryer are located in the garage, cleaning supplies and disinfectants are stored locked in the garage. There is a sufficient supply of emergency food and water.

RECORDS: Record review began at 10:25AM. Resident records were reviewed for, but not limited to: care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order.

MEDICATIONS: Medications review began at 12:44PM. Medications are centrally stored locked in the medication closet located at the entrance of the facility. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed both the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually, as required. Facility conducts emergency disaster drills quarterly, with the last drill documented on 11/17/2024.

No deficiencies cited. Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

LIC809 (FAS) - (06/04)

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