Facility Evaluation Report

California Needs and Services, Simi Valley09/13/2021Licence 567610003

Capacity4
Census4
Date signed09/13/2021 10:00:48 AM
The inspector’s account

Licensing Program Analyst (LPA) Salia Walker arrived at the facility unannounced to conduct a required Annual visit at 08:45 a.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Licensee Kenneth Carpenter at 08:55 a.m. and explained the reason for the visit.

The LPA toured the physical plant areas inside and outside, with Kenneth Carpenter at 08:56 a.m., to ensure there are no health and safety hazards.

BEDROOMS: The LPA observed the resident bedrooms which were furnished with clean linens, appropriate furnishings, and sufficient lighting.

RESTROOMS : Resident restrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap, and paper products. The LPA advised the Licensee to ensure that all bathrooms had hand-washing signs. Restroom one (1) hot water measured 105.7 Fahrenheit at 09:00 a.m. Restroom two (2) hot water measured 105.2 Fahrenheit at 09:07 a.m.

KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be properly stored and locked at time of visit. Hot water measured 105.8 Fahrenheit at 09:02 a.m.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA did not observe required postings in the facility in regard to CDSS PINS and CDSS PIN Summaries. One fire extinguisher was observed to be fully charged and purchased on 10/2020.

BACKYARD: The backyard has a covered outdoor area equipped with furniture for client use. There were no bodies of water noted. The garage contains additional nonperishable and perishable food items. The garage is attached to the facility.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction