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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802451
Report Date: 01/27/2025
Date Signed: 01/27/2025 10:45:35 AM

Document Has Been Signed on 01/27/2025 10:45 AM - 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:PHOENIX8-1,LINCOLNFACILITY NUMBER:
565802451
ADMINISTRATOR/
DIRECTOR:		SUSANA L. MIXFACILITY TYPE:
735
ADDRESS:1900 LINCOLN CTTELEPHONE:
(805) 488-3923
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 9CENSUS: 6DATE:
01/27/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Rosemarie SironTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:20 a.m., the LPA met with staff and explained the reason for the visit. The Administrator was not available during the time of the visit, and authorized staff, Rosemarie Siron to sign the report. This home is vendored by Tri-Counties Regional Center as a level 4-C home.

Starting at 9:36 a.m., the LPA, along with staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards.

KITCHEN: The kitchen and food storage areas were observed. Kitchen appliances appeared to be in operable condition. At 9:43 a.m., hot water temperature measured at 116.8-degree Fahrenheit. Knives are stored in a locked kitchen drawer. 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 extinguishers were fully charged and purchased on 03/12/2024. The carbon monoxide detector and smoke detectors were tested and were operational. Medications are centrally stored and in a locked filing cabinet in the dining room. Cleaning supplies and items that could pose a danger were secured in locked a cabinet inside the garage. Laundry units are located inside the garage. The backyard has covered seating for client use. BEDROOMS: There are six (6) client bedrooms and one (1) office. The LPA observed the client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: The facility has three (3) 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: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2025
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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