565802442-10-7-2022-29-AS-KLOZ-CJZ23T-20221007170253

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565802442
Report Date: 10/07/2022
Date Signed: 10/07/2022 05:04:12 PM

Document Has Been Signed on 10/07/2022 05:04 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:	R&J RESIDENTIAL CARE HOME		FACILITY NUMBER:	565802442
ADMINISTRATOR:	CARINO, CHRISTIAN RYAN		FACILITY TYPE:	740
ADDRESS:	2160 HANCOCK PL		TELEPHONE:	(805) 253-0483
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	4	CENSUS: 4	DATE:	10/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:46 PM
MET WITH:	Christian Ryan Carino		TIME COMPLETED:	03:35 PM

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Licensing Program Analyst (LPA) KaSandra Lopez arrived at 2:46 PM and conducted an unannounced Require - 1 Year inspection at the facility today. This annual had a specific emphasis on infection control practices and procedures. When the LPA arrived there were two staff and four residents. Administrator Ryan Carino arrived during the inspection.

The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The carbon monoxide and smoke alarms were tested at 2:53 PM and all functioned properly. The fire extinguisher is fully charged and last serviced 10/11/2021.

KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Knives and medications are stored in locked cabinets.

COMMON SPACES: Living room and dining room furniture was observed to be in good condition. The LPA observed the required postings upon entry. The backyard patio is equipped with furniture for clients' use. Cleaning supplies are stored in locked cabinets in the garage.

BEDROOMS: The LPA observed four client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There is one staff bedroom.

RESTROOMS: There is one common and one private restroom for resident use which were clean and sanitary and in operating condition with hand soap and paper towels. At 3:04 PM, the hot water temperature tested at 107.6 degrees F. in the hallway restroom.

COMMON SPACES: Living room and dining room furniture was observed to be in good condition. The LPA observed the required postings upon entry. The backyard patio is equipped with furniture for clients' use. Medications are stored in a locked cabinet in the dining room area. Records are stored in a locked cabinet in the office.

Report continued on LIC 809-C.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

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: R&J RESIDENTIAL CARE HOME	FACILITY NUMBER: 565802442
	VISIT DATE: 10/07/2022

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INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening and sanitation station. All facility staff were observed wearing masks. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility has appropriate plans in place in the event of clients and/or staff are showing symptoms of COVID-19 or testing positive for COVID-19.

No deficiencies observed during the inspection. Exit interview conducted. Report emailed to Administrator.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

LIC809 (FAS) - (06/04)

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