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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802410
Report Date: 01/11/2024
Date Signed: 01/11/2024 02:59:53 PM

Document Has Been Signed on 01/11/2024 02:59 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:PEOPLE'S CARE GOODENOUGHFACILITY NUMBER:
565802410
ADMINISTRATOR:DANIELA MOSQUERAFACILITY TYPE:
735
ADDRESS:2591 GOODENOUGH RDTELEPHONE:
(805) 524-5617
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY: 6CENSUS: 6DATE:
01/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:12 AM
MET WITH:Daniela MosqueraTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced required annual visit
to the above facility. LPA met with administrator Daniela Mosquera and explained the reason for the visit.

LPA conducted a tour of the physical plant areas inside and outside to ensure there are no health and safety hazards. This home is vendor by Tri-Counties Regional Center. The smoke detectors and carbon monoxide detectors were tested and functioned properly during the visit. The fire extinguishers were last serviced on 2/27/2023 and appeared full.

BEDROOMS: There are six client bedrooms; four rooms on the permanent side and two rooms on the crisis side. All rooms were clean, appropriately furnished and had sufficient lighting.

RESTROOMS: There are three (3) bathrooms at the home. Two on the permanent side and one on the crisis side. The bathrooms were clean and had non-skid mats. Hot water temperature was tested at 107*F.

KITCHEN: The kitchen appliances appeared functional. Knives were stored in a locked safe on the counter. Cleaning supplies are stored in a locked cabinet in the hall near the entry.

MEDICATIONS: The medications are stored in a locked cabinet in a small office near the entryway. There is a computer located in the office for clients' use. LPA reviewed medications and the centrally stored medication and destruction records. Medications appear to be given as prescribed.


(continued on 809-C)
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2024
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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PEOPLE'S CARE GOODENOUGH
FACILITY NUMBER: 565802410
VISIT DATE: 01/11/2024
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(continued from 809)


OUTSIDE: The facility has an in ground pool that is fully fenced with a six foot tall fence and a gate which is kept locked when not in use. There are two covered patios and a lounging area under a large tree. There is also a basketball court area. This facility has perimeter fencing and a locked entry gate.

CLIENT RECORDS: Five (5) client files were reviewed. All documentation reviewed was found complete and in each client's file. LPA was unable to interview clients as all six (6) clients were out in the community.

STAFF RECORDS: Five (5) staff files were reviewed. All documentation was found complete and in each staff's file. LPA interviewed two staff; there were no concerns.

DISASTER PLAN: LPA reviewed the facility's disaster plan which appeared complete. The Administrator will ensure it is kept updated as needed and review the information at minimum annually. The facility conducts three (3) disaster drills each month.

INFECTION CONTROL: LPA observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. All clients have their own bedroom and the facility has the capacity to designate a single bathroom for those clients in isolation due to an infectious disease.

No deficiencies were observed during today's visit. Report was reviewed and provided to the administrator.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC809 (FAS) - (06/04)
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