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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802410
Report Date: 01/06/2025
Date Signed: 01/06/2025 02:35:20 PM

Document Has Been Signed on 01/06/2025 02:35 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:PEOPLE'S CARE GOODENOUGHFACILITY NUMBER:
565802410
ADMINISTRATOR/
DIRECTOR:		DANIELA MOSQUERAFACILITY TYPE:
735
ADDRESS:2591 GOODENOUGH RDTELEPHONE:
(805) 524-5617
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY: 6CENSUS: 6DATE:
01/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Daniela Mosquera TIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Brian Balisi  conducted an unannounced required annual visit
to the above facility. LPA met with administrator Daniela Mosquera and explained the reason for the visit. There were no clients present during 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 observed fully charged and  last serviced on June 05, 2024. Fire alarm devices were last inspected of August of 2024.

There are six client bedrooms; four rooms on the permanent side and two rooms on the crisis side. All rooms were observed to be clean, appropriately furnished and had sufficient lighting during the time of the visit.

 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 between 105 - 120 degrees Fahrenheit.

The kitchen appliances appeared clean and operational at the time of the visit. . Knives were observed stored in a locked safe on the counter. Cleaning supplies are stored in a locked cabinet in the hall near the entry.

The medications are centrally stored in a locked cabinet in a small office near the entryway. There is a computer located in the office for clients' use. PPE, residents personal snacks and other facility supplies were observed stored inaccessible in cabinets to the right of the entrance. A sufficient supply of emergency water was observed properly stored in entry way closet.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2025
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: PEOPLE'S CARE GOODENOUGH
FACILITY NUMBER: 565802410
VISIT DATE: 01/06/2025
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The kitchen appliances appeared clean and operational at the time of the visit. . Knives were observed stored in a locked safe on the counter. Cleaning supplies are stored in a locked cabinet in the hall near the entry.

The medications are centrally stored in a locked cabinet in a small office near the entryway. There is a computer located in the office for clients' use. PPE, residents personal snacks and other facility supplies were observed stored inaccessible in cabinets to the right of the entrance. A sufficient supply of emergency water was observed properly stored in entry way closet.

Five (5) individual records were reviewed for the following: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, Individual Program Plans (IPP), and current needs and services plan. All participant records were in order at this time. The LPA reviewed six (6) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, and valid first aid/CPR. Training records on file. All staff records were in order at this time.

Medications review began at approximately 01:00 p.m. Medications are centrally stored and locked inside a cabinet in the LVN’s office. All medications including PRNs were labeled, stored and locked inaccessible to individuals. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during medications review.

LPA reviewed the facility's disaster plan which appeared complete. The facility conducts three (3) disaster drills each month. Last one was conducted on 12/24/2024.

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: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC809 (FAS) - (06/04)
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