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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850318
Report Date: 01/12/2024
Date Signed: 01/12/2024 12:52:55 PM

Document Has Been Signed on 01/12/2024 12:52 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:ARTHUR FAMILY HOMEFACILITY NUMBER:
565850318
ADMINISTRATOR:ARTHUR, AKOSUAFACILITY TYPE:
735
ADDRESS:1512 ALMANOR STREETTELEPHONE:
(805) 248-8099
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY: 4CENSUS: 3DATE:
01/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Akosua ArthurTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced Required - 1 Year inspection at the facility today. When the LPA arrived there were two staff present and one client getting ready for their day program; all other clients were at their day programs. LPA met with Administrator Akosua Arthur. This home is vendored by Tri-Counties Regional Center as a level two home.

The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

KITCHEN: The kitchen and food storage areas were observed. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food stored in the kitchen, a closet and garage. Cleaning supplies and items that could pose a danger were secured in locked cabinets. The facility has a supply of emergency food and water.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and condition. 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 extinguisher was fully charged and last serviced on 1/8/2024. The carbon monoxide detector and smoke detectors in the home and bedrooms were tested and were operational. Medications are centrally stored and in a locked cabinet in the office area. Cleaning supplies were observed to be locked in a cabinet. The backyard has covered seating for resident use.

BEDROOMS: There are three client bedrooms and one staff bedroom. The LPA observed the client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.




(continued on LIC 809-C)
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: ARTHUR FAMILY HOME
FACILITY NUMBER: 565850318
VISIT DATE: 01/12/2024
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(continued from LIC 809)

RESTROOMS: The facility has two common restrooms for client use. Restrooms were observed to be clean and sanitary with hand soap, toilet paper and paper towels. The hot water temperature in the bathrooms measured 114.6*F - 116.8*F.

MEDICATIONS: Medications are locked and centrally stored in a locked cabinet in the office area. LPA reviewed medications. All medications are labeled and maintained in compliance with label instructions, and state and federal law. All medications reviewed were recorded on the centrally stored medication and destruction record and appear to be given as prescribed.

RECORDS: LPA reviewed client and staff files; all were complete. LPA reviewed the facility disaster plan which was complete. Evacuation/Disaster drills are conducted monthly. The facility has a 30 day supply of personal protective equipment and can obtain more if necessary.

INTERVIEWS: LPA interviewed one staff; there were no concerns. All clients were at day program.

No deficiencies were cited during today's inspection. Exit interview and reported reviewed with the Administrator. A copy of the report was provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024
LIC809 (FAS) - (06/04)
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