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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801925
Report Date: 07/03/2024
Date Signed: 07/03/2024 12:00:09 PM

Document Has Been Signed on 07/03/2024 12:00 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 IIIFACILITY NUMBER:
565801925
ADMINISTRATOR/
DIRECTOR:
BENJAMIN G. ABUTIN JR.FACILITY TYPE:
735
ADDRESS:3100 OARFISH LANETELEPHONE:
(805) 984-8287
CITY:OXNARDSTATE: CAZIP CODE:
93035
CAPACITY: 6CENSUS: 6DATE:
07/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Benjamin G. Abutin and Joyce Abutin, AdministratorsTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. During the time of the visit all clients were at their day programs and/or out in the community. At 10:35 a.m., the LPA met with Administrators Benjamin G. Abutin and Joyce Abutin. This home is vendored by Tri-Counties Regional Center as a level 4 home.

Starting at 11:11 a.m., the LPA, along with 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.
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. The facility has a supply of emergency food and water. COMMON SPACES: 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 07/18/2023. The carbon monoxide detector and smoke detectors were tested and were operational. Medications are centrally stored and in a locked cabinet in the dining room. Cleaning supplies and items that could pose a danger were secured in locked cabinets inside the garage. Laundry units are located inside the garage. The backyard has covered seating for client use. BEDROOMS: There are four client bedrooms and one staff bedroom. The LPA observed the client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: The facility has three restrooms. Restrooms were observed to be clean and sanitary with hand soap, toilet paper and paper towels. The hot water temperature in restrooms measured within required range.

Due to time constraints the LPA will return to complete the annual at a later date.
No deficiencies were cited during today's inspection. Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
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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