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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850589
Report Date: 03/11/2025
Date Signed: 03/11/2025 12:55:06 PM

Document Has Been Signed on 03/11/2025 12:55 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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:LIFETOUCH THE ELEGANT LIVING RESIDENTIAL HOME CAREFACILITY NUMBER:
405850589
ADMINISTRATOR/
DIRECTOR:
AQUINO, AMELITA I.FACILITY TYPE:
740
ADDRESS:1711 KLECK RDTELEPHONE:
(805) 878-3409
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 6CENSUS: 0DATE:
03/11/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Administrator, Amelita AquinoTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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At 11:00am on 03/11/2025, Licensing Program Analyst (LPAs) Haner-Tomasko and Jeffries arrived at the scheduled time to conduct the facilities pre licensing inspection. LPA met with Administrator Amelita Aquino announced who they are and the reason for the visit.

Administrator and LPAs conducted a physical tour of the facility. This facility has a centrally located full kitchen, two living rooms, 4 resident bedrooms, two of the resident bedrooms are double resident occupancy and two are single resident occupancy bedrooms and staff bedroom. There is a laundry room that will require a lock on the laundry room door that has not yet been installed as of 03/11/2025. There are two outside areas for resident outside activities. The front of the facility has a small area for visitation and the back yard has a covered patio for shade and is large enough for outside activities. LPAs noted that the facility requires a replacement carbon monoxide detector and replacement smoke detector in resident bedroom #`1. LPA's observed a medication closet that has a lock on the closet door in the hallway next to the laundry room. LPA's observed a new and complete first aide kit in the medication closet. LPA's noted that the facility is clean and in good repair. LPA's noted that there is a working fire extinguisher in the kitchen area. LPA's noted that the facility is clean and in good repair, hallways and door ways are free and clear of debit. LPA noted that screens on window and door slider in resident bedroom #3 needed to be repaired.

Administrator and LPA's conducted a full review of the pre licensing care tools. Administrator and LPA's conducted a full review of the Comp III training tools for review as this licensee has two active licensed facilities. LPA's will have to return at a later date to observed the replacement (smoke and carbon monoxide detectors) items, and repaired items Bedroom #3 (window and door screens) before authorizations of license is submitted for completion..

Exit interview, report read, and report provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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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