565801899-12-11-2024-29-AS-KDUK-DBV3QB-20241211172651

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801899
Report Date: 12/11/2024
Date Signed: 12/11/2024 07:57:11 PM

Document Has Been Signed on 12/11/2024 07:57 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:	BRIO MANOR		FACILITY NUMBER:	565801899
ADMINISTRATOR/ DIRECTOR:	JOHNEIL BRIONES		FACILITY TYPE:	740
ADDRESS:	115 THAMES STREET		TELEPHONE:	(805) 379-9698
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	12/11/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:43 PM
MET WITH:	Johneil Briones		TIME VISIT/ INSPECTION COMPLETED:	05:35 PM

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Licensing Program Analyst (LPA) Kelly Dulek arrived unannounced to conduct a Required Annual Inspection. Upon arrival, LPA was greeted at the door by House Manager Maria Veronica Large and the reason for the visit was explained. The Licensee, Johneil Briones, arrived at approximately 03:45PM. Entrance interview conducted.

Beginning at 01:58PM, the LPA, along with House Manager toured the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

BEDROOMS: There are 5 (five) resident rooms and 1 (one) staff room. LPA observed the resident rooms, which were furnished appropriately with clean linens, furnishings, and sufficient lighting.

RESTROOMS: There are two (2) resident restrooms, one in the hallway and another in the master bedroom. Both restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Restrooms are sufficiently stocked with liquid hand soap and paper towels. Restrooms were measured for hot water, which measured within the required range.

KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of seven (7) days perishable and two (2) days non-perishable food. The LPA observed all knives and sharps locked in a drawer inaccessible to residents. Cleaning supplies and toxins were observed locked under the kitchen sink.

GARAGE AND GROUNDS: The garage is locked and attached to the house. There is another refrigerator in the garage with additional food. The LPA observed a sufficient supply of emergency water and food. Two (2) fire extinguishers were observed to be fully charged and recently purchased 12/07/2024. The facility maintains at a temperature. There is a covered patio area with patio furniture including a table and chairs for resident use. Facility has two (2) fence gates that self-latch with clear passageways for emergency exit use. The backyard contains a pool, which was fenced and locked appropriately.

Report Continued on 809-C

Kristin Heffernan	TELEPHONE: (818) 596-4493
Kelly Dulek	TELEPHONE: (951) 836-3170
	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

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: BRIO MANOR	FACILITY NUMBER: 565801899
	VISIT DATE: 12/11/2024

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COMMON SPACES: The living and dining areas are clean and properly furnished with seating, a table, and television for resident use. The living room does have a fireplace, which was observed screened and inaccessible to residents in care. Combination smoke and carbon monoxide detector was tested at 04:39PM and was functional at the time of the visit.

RECORDS: Records will be reviewed during the annual continuation visit

MEDICATIONS: Medications will be reviewed during the annual continuation visit.

INFECTION CONTROL/EMERGENCY DISASTER PLAN: Will be reviewed during the annual continuation visit.

No citations issued. 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: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

LIC809 (FAS) - (06/04)

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