565850318-1-8-2025-29-AS-ECOZ-DCQULL-20250108144055

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850318
Report Date: 01/08/2025
Date Signed: 01/08/2025 02:41:03 PM

Document Has Been Signed on 01/08/2025 02:41 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 HOME		FACILITY NUMBER:	565850318
ADMINISTRATOR/ DIRECTOR:	ARTHUR, AKOSUA		FACILITY TYPE:	735
ADDRESS:	1512 ALMANOR STREET		TELEPHONE:	(805) 248-8099
CITY:	OXNARD	STATE: CA	ZIP CODE:	93030
CAPACITY: 4		CENSUS: 4	DATE:	01/08/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:15 AM
MET WITH:	Akusua Arthur		TIME VISIT/ INSPECTION COMPLETED:	02:45 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) Esther Cortez conducted an unannounced Required - 1 Year inspection at the facility today. The LPA met with staff and explained the reason for the visit. When the LPA arrived there were two staff present and one client; all other clients were at their day programs. Administrator Akosua Arthur arrived at approximately 11:45 a.m. The home was experiencing a power outage during the visit. LPA and Administrator discussed emergency disaster plan, and best practices.

At 10:25 a.m., the LPA conducted a tour of the physical plant with Staff to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a double-story residence that consists of three (3) client bedrooms, one (1) staff room and two (2) bathrooms. The home is vendored by Tri-Counties Regional Center as a level 2 home. The LPA observed fire extinguishers, which were fully charged and last serviced 12/31/2024. All smoke alarms and carbon monoxide detectors were tested and operable. LPA observed all required postings in the office area.

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 backyard has covered seating for resident use.

BEDROOMS: The LPA observed the client bedrooms, which were furnished appropriately with clean linens, and appropriate furnishings.

(continued on LIC 809-C)

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

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: 01/08/2025

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
26
27
28
29
30
31
32

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 between 108.1*F - 110.8*F.

RECORDS: At 10:45 a.m. a review of facility files was initiated. The LPA reviewed all client and all staff files; all were complete. The LPA observed documentation of Infection Control, Disaster prevention and last Disaster drill (conducted on 12/14/2024). The facility has a 30 day supply of personal protective equipment and can obtain more if necessary.

MEDICATIONS: Medications are locked and centrally stored in a locked cabinet in the office area. LPA reviewed medications for three clients. 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.

INTERVIEWS: LPA interviewed one staff and one client, there were no concerns. All other 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: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

LIC809 (FAS) - (06/04)

Page: 2 of 2