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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850318
Report Date: 12/21/2022
Date Signed: 12/21/2022 02:16:07 PM

Document Has Been Signed on 12/21/2022 02:16 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:ARTHUR FAMILY HOMEFACILITY NUMBER:
565850318
ADMINISTRATOR:ARTHUR, AKOSUAFACILITY TYPE:
735
ADDRESS:1512 ALMANOR STREETTELEPHONE:
(805) 248-8099
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY: 6CENSUS: 0DATE:
12/21/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Akosua ArthurTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) KaSandra Lopez conducted a pre-licensing visit to the above noted facility. The LPA met with applicant, Akosua Arthur. This application is a change of ownership. The home is currently licensed as Arthur Family Home 565850065. The home will be vendored by Tri-Counties Regional Center as a level II home. Component III was completed during today's inspection.

At 9:25 AM, a physical plant tour was conducted inside and out. The facility is a two story home. An approved fire clearance was received, clearing the facility for six ambulatory residents. All resident rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linens. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture. In addition, no bedroom was used as a passageway to another room, bath or toilet. The master bedroom is designated as a staff room. All rooms were free of odors. All window screens were clean and maintained in good repair.

There is one common bathroom on the first floor and second common bathroom on the second floor. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F. Resident and staff records are stored in a locked cabinet which is currently located in the office. Medications and cleaning supplies are also centrally stored in locked cabinets in the office The first aid supplies were complete, including a thermometer and a current version of a first aid manual.

Kitchen knives are stored in a locked box in the pantry. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of perishable and nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. No flies or other vermin were observed. Report continued on LIC 809-C.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2022
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: ARTHUR FAMILY HOME
FACILITY NUMBER: 565850318
VISIT DATE: 12/21/2022
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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 living room and dining area. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to non-private bathrooms. All rugs contained non-slip material underneath. There is a fireplace in the living room. It is screened and there are no tools. 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. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit.

The facility smoke alarm system is hard wired. There is a pull station on each floor. The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. There are two fire extinguishers throughout the house. They are fully charged and do not exceed the expiration date of 02/07/2022. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in locked cabinets. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted. The emergency telephone numbers are posted in office. The exterior passageways were clean and clear of any obstructions. There is a covered patio table in the back yard for resident use. The entire property is fenced. There is a door w/gate with a self-latching mechanism for persons to enter the front yard. There is no shed on the premises. There are no bodies of water on the premises at the present time. The garage is accessible from the house and there are no items that could pose a danger accessible to residents. Pre-Licensing is complete and this facility has no deficiencies.


This report will be sent to the Centralized Application Bureau (CAB). 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: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
LIC809 (FAS) - (06/04)
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