565850244-5-31-2022-29-AS-AASO-CEXSJ6-20220531135436

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850244
Report Date: 05/31/2022
Date Signed: 05/31/2022 01:55:41 PM

Document Has Been Signed on 05/31/2022 01:55 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:	PALS SKILLS CENTER		FACILITY NUMBER:	565850244
ADMINISTRATOR:	OKATCH, OTIENO		FACILITY TYPE:	775
ADDRESS:	1310 E MAIN STREET		TELEPHONE:	(562) 489-3859
CITY:	SANTA PAULA	STATE: CA	ZIP CODE:	93060
CAPACITY: 30		CENSUS: 0	DATE:	05/31/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Otieno Okatch		TIME COMPLETED:	12:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Angel Ascencio conducted a pre-licensing visit to the above noted facility. The LPA met with applicants, Otieno Okatch and Christina Butch-Okatch. This is a new facility. This facility is vendored through Tri-Counties Regional Center. The facility is one story facility. At 10:12 a.m., a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for five (5) non-ambulatory participants and twenty-five (25) ambulatory participants. The facility has 7 rooms which include 4 rooms for activities, a conference room, infirmary room and an office room. There are no staff rooms. All window screens were clean and maintained in good repair. There are two (2) bathrooms in the hallway. The participant bathrooms have non-skid materials. The toilets have grab bars. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105F and 120F. Participant and staff records are stored in a filing cabinet which is currently located in the Reception Area. Medications are centrally stored in a locked cabinet in the Reception Area. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in the facility kitchen. Kitchen knives are stored in a locked storage room by the kitchen. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0F) and the refrigerator was maintained at 40F. The supply of nonperishable food is adequate. There are no pesticides or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Continued on LIC 809 - C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022

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: PALS SKILLS CENTER	FACILITY NUMBER: 565850244
	VISIT DATE: 05/31/2022

NARRATIVE

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Kitchen, laundry and house cleaning supplies are stored in a locked storage room. No flies or other vermin were observed.

The common areas were appropriately furnished, and the lighting was adequate. There are televisions and other entertainment equipment, games and/or activity supplies in the activity rooms. There was sufficient space to accommodate both indoor and outdoor activities. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. They have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit.

The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit.

There are three (3) fire extinguishers throughout the facility. They are fully charged and do not exceed the expiration date. Hot water was tested in each bathroom. Hot water in the kitchen ranged of 105*F and 120*F. . There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted throughout the hallways. The emergency telephone numbers are posted in reception area. Other required postings are posted in the hallways. There are no bodies of water on the premises at the present time.

The following items must be corrected prior to licensure. Submit proof of corrections, along with a copy of this report, to LPA Ascencio, so that your application may be completed.

- 3 Activity rooms need Smoke detectors

This report will be sent to the Centralized Application Bureau (CAB) once all corrections are received. You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022

LIC809 (FAS) - (06/04)

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