565801923-7-8-2024-29-AS-ECOZ-D6YSQN-20240708140500

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801923
Report Date: 07/08/2024
Date Signed: 07/08/2024 02:05:11 PM

Document Has Been Signed on 07/08/2024 02:05 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:	ABUTIN CARE HOME I		FACILITY NUMBER:	565801923
ADMINISTRATOR/ DIRECTOR:	JOYCE ABUTIN		FACILITY TYPE:	735
ADDRESS:	603 E. IRIS STREET		TELEPHONE:	(805) 240-0095
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY: 6		CENSUS: 5	DATE:	07/08/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:45 AM
MET WITH:	Ben Abutin		TIME VISIT/ INSPECTION COMPLETED:	02:10 PM

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Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Required - 1 Year inspection at the facility today. When the LPA arrived there was only one staff present as all the clients were at their day programs. The LPA met with Co-Administrator Ben Abutin and explained the reason for the visit. This home is vendored by Tri-Counties Regional Center as a level three home.

The LPA and the administrator 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 in the kitchen and garage. Cleaning supplies and items that could pose a danger were secured in locked cabinets. The facility has a supply of emergency food and water.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and condition. All indoor and outdoor passages were free of obstruction. At the time of the visit, living room and dining room furniture was observed to be in good condition. The fire extinguisher was fully charged and last serviced on 07/17/2023. The fire extinguisher is scheduled for service on 07/16/2024. At 11:11 a.m. the carbon monoxide detector and smoke detectors in the home and bedrooms were tested and were operational. Medications are centrally stored and in a locked cabinet in the dinning room. Cleaning supplies were observed to be locked in the laundry area and garage and inaccessible to residents in care. The backyard has covered seating for resident use.

BEDROOMS: There are three client bedrooms and one staff bedroom. The LPA observed the client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Report continued on LIC 809-C

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024

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: ABUTIN CARE HOME I	FACILITY NUMBER: 565801923
	VISIT DATE: 07/08/2024

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RESTROOMS: The facility has two common restrooms for client use. Restrooms were observed to be clean and sanitary with hand soap, toilet paper and paper towels. At 11:20 a.m. the hot water temperature in the common hallway restrooms measured between 106.3 degrees F and 120.6 degrees F. Upon observation, administrator adjusted the water temperature.

RECORDS: At 11:25 a.m. a review of facility files was initiated. Facility records are stored in a locked cabinet in the living area. The LPA observed documentation of Infection Control, Disaster prevention and last emergency drill (conducted on 06/28/2024). The LPA reviewed P&I money and records with the Administrator. Cash resources for all five clients were separate and intact, and not be commingled with facility funds or petty cash. The facility has a current surety bond on file. The five client files reviewed were found to be complete. Five staff files were reviewed and also found to be complete. The facility has a 30 day supply of personal protective equipment.

MEDICATIONS: Medications are locked and centrally stored in a locked cabinet in the dining room area. At 1:00 p.m. 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: Interviews with one staff and one (1) client were conducted. No issues or concerns revealed.

No deficiencies were cited during today's inspection. Exit interview and reported reviewed with the Administrator. A copy of the report was provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024

LIC809 (FAS) - (06/04)

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