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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850071
Report Date: 04/12/2022
Date Signed: 04/12/2022 03:09:45 PM

Document Has Been Signed on 04/12/2022 03:09 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:CARE FOR PEOPLEFACILITY NUMBER:
565850071
ADMINISTRATOR:JOLLY PADAYAOFACILITY TYPE:
735
ADDRESS:1545 CHURCH STREETTELEPHONE:
(805) 285-0619
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 4CENSUS: 3DATE:
04/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Jolly Padayao and Betsy InsularTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Ashley Smith arrived at the facility unannounced at 12:20 p.m. for a required one year / post licensing annual inspection. The LPA met with Administrators Jolly Padayao and Betsy Insular and explained the reason for the visit.

The LPA toured the facility to ensure there are no health and safety hazards:

KITCHEN: Knives and sharp objects are stored in a locked cabinet in the kitchen. Cleaning supplies are stored locked and inaccessible to clients in the garage. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Staff tested the water temperature, and the hot water temperature measured at 112 degrees Fahrenheit.

BEDROOMS: The four client bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The facility has awake staff only and there is no designated staff room.

RESTROOMS: The restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Bathrooms were fully stocked with soap and paper towels.

COMMON SPACES: The LPA observed COVID-19 signs that promoted hand hygiene, physical distancing, and cough/sneeze etiquette. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required licensing postings listed throughout the facility. The fire extinguisher was fully charged and purchased 9/2021.

The backyard has a covered outdoor area equipped with furniture for client use. There is a door with a gate for persons to egress to the front yard. There were no bodies of water noted. The garage is kept unlocked. The garage is where the washer and dryer are held, including additional nonperishable and perishable food items. The LPA observed an adequate supply of Personal Protection Equipment (PPE) stored in the garage and the facility is able to obtain additional supplies as needed.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2022
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: CARE FOR PEOPLE
FACILITY NUMBER: 565850071
VISIT DATE: 04/12/2022
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RECORDS: Resident records were reviewed at 1:10 p.m. The LPA reviewed client files for, but not limited to: admissions agreements, medical assessment, updated care plans. Client files were in order. The LPA reviewed three personnel records, but not limited to: job application, health assessments, TB results, criminal record statements and clearances, first aid/CPR certification. Personnel records were in order.

MEDICATION: Medications review began at 2:00 p.m. The LPA reviewed medications for 2 clients. Medications are maintained locked inaccessible to clients in a cabinet in the hallway. Medications were in order. The first aid kit is fully stocked, along with a first aid manual.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrators regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19, as each client has their own room. This facility has records of staff and client vaccinations. The facility has previously managed COVID-19 active cases and the facility complied with all requirements set forth by the local health department and licensing. The facility’s policies and procedures pertaining to infection control were adequate.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022
LIC809 (FAS) - (06/04)
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