565850250-6-12-2024-29-AS-MRAN-D672G2-20240612172224

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850250
Report Date: 06/12/2024
Date Signed: 06/12/2024 05:22:44 PM

Document Has Been Signed on 06/12/2024 05:22 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:	ROWE RESIDENCE TULSA CIRCLE		FACILITY NUMBER:	565850250
ADMINISTRATOR/ DIRECTOR:	ROWE, CHRISTINE		FACILITY TYPE:	740
ADDRESS:	10446 TULSA CIRCLE		TELEPHONE:	(805) 293-9227
CITY:	VENTURA	STATE: CA	ZIP CODE:	93004
CAPACITY: 6		CENSUS: 6	DATE:	06/12/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:55 PM
MET WITH:	Christina Rowe		TIME VISIT/ INSPECTION COMPLETED:	05:30 PM

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Licensing Program Analyst (LPA) Melisa Rankin arrived at the facility unannounced to conduct a required annual visit at 1:55 p.m. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Christine Rowe arrived shortly thereafter.

The LPA and the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: The LPA began the inspection in the kitchen/food service area at 2:45 p.m. Knives are stored inaccessible. Kitchen appliances were in clean and operable condition. The facility has a sufficient supply of perishable and non-perishable food. The garage is secured with a lock from inside the kitchen. The garage is where the washer and dryer are held, including emergency perishable food items.

COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. Carbon monoxide detector were tested and operational at the time of the visit. The two (2) fire extinguishers were fully charged, annual service is scheduled for 6/21/24. The LPA observed required postings throughout the common space.

The backyard has a covered outdoor area equipped with furniture for client use. There are side gates for client use and is single latched, right gate will be oiled and spring tightened. No bodies of water noted.

Report continued on LIC 809-C.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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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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: ROWE RESIDENCE TULSA CIRCLE	FACILITY NUMBER: 565850250
	VISIT DATE: 06/12/2024

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BEDROOMS: The LPA observed the client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There are six designated client rooms.

RESTROOMS: The two client restrooms were clean and sanitary and in operating condition with grab bars and non-skid mats. The bathrooms were sufficiently stocked with soap and paper towels.

MEDICATIONS: Medications review began at 4:02 p.m.; medications are centrally stored and locked in a cabinet in the kitchen; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications. No errors observed during the medication review.

RECORDS: Facility records were reviewed. Three client records were reviewed for, but not limited to: care plans, medical records, admissions agreement, and consent forms. All records were in order.

Three personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate annual 20 hour training. All records were in order.

Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

LIC809 (FAS) - (06/04)

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