565850260-9-10-2024-29-AS-VCOY-D8YV58-20240910160731

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850260
Report Date: 09/05/2024
Date Signed: 09/10/2024 04:07:47 PM

Document Has Been Signed on 09/10/2024 04:07 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	BEST OF CARE HOMES, INC.		FACILITY NUMBER:	565850260
ADMINISTRATOR/ DIRECTOR:	ARCENAS, OSKAR KYLE		FACILITY TYPE:	735
ADDRESS:	1742 EUCLID AVENUE		TELEPHONE:	(805) 758-3474
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93010
CAPACITY: 4		CENSUS: 4	DATE:	09/05/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:25 AM
MET WITH:	Oskar Arcenas		TIME VISIT/ INSPECTION COMPLETED:	03:00 PM

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Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct an annual visit. LPA arrived at 09:20 A.M. and initially met with facility staff Josephine Almazan. Administrator, Oskar Arcenas, was contacted and arrived at the facility at approximately 10:00 A.M. Entrance interview conducted.

Beginning at 10:10 A.M., the LPA along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

The facility is vendored through Tri-Counties Regional Center as a Level 3 home. Fire extinguishers are fully charged and last serviced on 07/15/2024. Hardwired combination smoke detectors and carbon monoxide were tested at 10:52 A.M., and were functional at the time of the visit. No fire clearance concerns were observed. his facility doesn’t have a staff room, facility will provide 24/7 care.

Bedrooms: There are 4 total bedrooms in the facility. All four (4) are private client bedrooms. All four (4) client bedrooms were observed and appeared clean, with appropriate linens and furnishings. LPA observed a sufficient supply of linen in the hallway closet.

Bathrooms: LPA observed all 2 and 1/2 bathrooms were clean, properly supplied and had functional fixtures. LPA observed all bathrooms to have non-skid mats. Clients have sufficient amounts of supplies for personal hygiene. Water temperature was measured in all client restrooms and measured within the required range.

Continued on LIC 809-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: BEST OF CARE HOMES, INC.	FACILITY NUMBER: 565850260
	VISIT DATE: 09/05/2024

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Continued from LIC 809

Common Areas: These included the dining area and living room. The common areas were checked for cleanliness. At the time of the visit, walls, flooring, and furniture were observed to be in good condition. A fireplace, which was properly screened, was observed in the living room. LPA observed cameras in the common areas and a Ring doorbell at the main entrance. A complete first aid kit was located in a closet next to the main entrance. There is a functioning telephone on the premises.

Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives and sharp objects are stored locked in under-sink cabinets. At 10:20 A.M., hot water was measured at 109.3 degrees Fahrenheit.

Laundry Area: There is a laundry area available for client use. Cleaning supplies were stored in cabinets above washer and dryer and inaccessible to residents in care at this time. All cleaning compounds were stored in areas separately from food supplies.

Surrounding Grounds (Outdoors): There was a shaded area with proper furniture for outdoor use and sufficient room for activities. There are no bodies of water on the premises. Three (3) outdoor sheds were observed to be locked. There is a gate in each side of the facility with a self-latching mechanism for persons to easily exit the property in the event of an emergency. The exterior passageways were clean and clear of any obstructions.

Garage: Garage was observed unlocked and contained extra food, staff area, emergency water and storage.

Continued from LIC 809-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: BEST OF CARE HOMES, INC.	FACILITY NUMBER: 565850260
	VISIT DATE: 09/05/2024

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Continued from LIC 809-C

Record Review/Medication Review: Medication review began at 11:17 A.M. Medications for all four (4) clients were observed. All medications observed were labeled, stored, and properly documented at the time of the visit. Facility properly documents medication on the Centrally Store Medication and Destruction log. Record review began at 12:25 P.M. Staff and client records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, client physician's report, needs and service appraisal, and personal rights. Five (5) staff files and all four (4) client files observed were in compliance with regulation. Cash resources for two (2) clients were reviewed and observed to be accurate and properly documented. Surety Bond in the amount of $2,000 is valid and will expire on June 6^th 2026. Last emergency drill was conducted on 07/06/2024.

Interviews: LPA interviewed one (1) staff at the time of the visit.

No citations given at this time. Exit interview conducted and report issued to the Administrator.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC809 (FAS) - (06/04)

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