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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610644
Report Date: 08/12/2025
Date Signed: 08/12/2025 02:01:55 PM

Document Has Been Signed on 08/12/2025 02:01 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:TOUCH OF AN ANGEL LANCASTERFACILITY NUMBER:
197610644
ADMINISTRATOR/
DIRECTOR:		THOMAS, STACYFACILITY TYPE:
740
ADDRESS:2647 WEST AVENUE K4TELEPHONE:
(323) 385-8298
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 6CENSUS: 3DATE:
08/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Stacy Thomas - AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Evelin Rios arrived at the facility above to conduct an unannounced annual required visit. LPA rang the door bell and was contacted by the administrator. LPA explained the reason for the visit. Administrator stated they were out in the community running errands and well meet LPA at the facility. LPA was greeted and granted access by staff #1(S1).

At approximately 10:20 am., LPA initiated the physical plant tour of the facility inside and out. The following was observed. LPA observed a sign in log for visitors by the entrance and required postings on a bulletin board by the dining table.



Kitchen: LPA conducted a tour of the kitchen at 10:25 a.m, and observed there to be sufficient amount of two-day perishables and seven-day non-perishables food. LPA also observed a deep freezer. Food storage and preparation areas were clear of clutter. LPA observed all knives and sharps locked and inaccessible to residents in care. The Medication cabinet was in the kitchen and was observed to be locked. LPA observed a fire extinguisher by the kitchen to be fully charged.

Bedrooms: There are three (3) bedrooms for residents' use. Bedrooms may be shared. Bedrooms were observed to be properly furnished with appropriate furniture, bedding and sufficient lighting. LPA observed extra linens in residents' closets.

Bathrooms: There are two (2) bathrooms for residents. One (1) bathroom is located in a shared bedroom for private use. Bathrooms were properly supplied with toilet paper, paper towels, hand soap, nonskid matts and grab bars. Hot water temperature was measured at 10:45 a.m., and read 116.2 degrees Fahrenheit.
NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: TOUCH OF AN ANGEL LANCASTER
FACILITY NUMBER: 197610644
VISIT DATE: 08/12/2025
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Common Areas: LPA observed the living areas and the dining areas to be neat and clean. At 12:14 p.m., the administrator tested the dual smoke detectors and carbon monoxide detectors and they were observed to be operational.

Laundry/Garage: LPA observed a washer and dryer in the garage. The garage is attached and accessible through one of two doors. Detergent and cleaning supplies are kept locked in a cabinet in the garage.

Surrounding Grounds: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with an outdoor umbrella for shade. No bodies of water observed. Entry/exits were free of obstruction.

Administrative: LPA reviewed facility's, Infection Control Plan, liability insurance and Emergency Disaster Plan (LIC610E).

Resident and Staff Files: At approximately 11:15 a.m., LPA conducted a file review of four (4) out four (4) resident records and three (03) staff files to insure compliance of licensing forms.



Medications: Centrally Stored Medication and Medication Records were reviewed for proper documentation. LPA observed a first aid kit fully stocked on the refrigerator.


No deficiencies cited. Exit interview was conducted. A copy of report provided.
NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
LIC809 (FAS) - (06/04)
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