<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197604989
Report Date: 02/29/2024
Date Signed: 02/29/2024 02:46:31 PM

Document Has Been Signed on 02/29/2024 02:46 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:DURANDO HOME IIFACILITY NUMBER:
197604989
ADMINISTRATOR:JAMES DURANDOFACILITY TYPE:
740
ADDRESS:38757 37TH STREET EASTTELEPHONE:
(661) 266-0551
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY: 4CENSUS: 3DATE:
02/29/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:James DurandoTIME COMPLETED:
02:55 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) Tihesha Smith made a subsequent visit to this facility at 12:35 pm to complete annual inspection from 02/24/2024. LPA disclosed to staff the purpose of the visit. The administrator was not present in the facility.

At 1:15 pm LPA reviewed staff and resident records. Staff records contained current First aid and CPR and trainings and resident records contained admissions agreements. IPPs have been requested and Administrator will email LPA.

Smoke detectors/carbon monoxide detector were tested and operable at time of visit 02/24/24. LPA Smith observed the following items that need to be address:

Window screens missing from resident bedroom next to front door

Window screens from other windows torn, ripped or missing

Walls thought facility need to be either cleaned, repaired and/or painted

Garage needs to be cleaned and items discarded

Deficiencies cited on 809D


Exit Interview/Copy of report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE: DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/29/2024
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 3
Document Has Been Signed on 02/29/2024 02:46 PM - It Cannot Be Edited


Created By: Tihesha Smith On 02/29/2024 at 02:33 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DURANDO HOME II
FACILITY NUMBER: 197604989

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)


This requirement is not met as evidenced by:
Walls in facility in disrepair/and not clean/window screens missing/ripped
Deficient Practice Statement
1
2
3
4
Based on observation the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/08/2024
Plan of Correction
1
2
3
4
Administrator will submit photos of correction
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Naira Margaryan
LICENSING EVALUATOR NAME:Tihesha Smith
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3