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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191221487
Report Date: 05/16/2022
Date Signed: 05/16/2022 11:23:07 AM

Document Has Been Signed on 05/16/2022 11:23 AM - 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:FENIQUITO RESIDENTIAL CAREFACILITY NUMBER:
191221487
ADMINISTRATOR:YVETTE FENIQUITOFACILITY TYPE:
735
ADDRESS:12933 WELBY WAYTELEPHONE:
(818) 220-8248
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 4CENSUS: 4DATE:
05/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Yvette FeniquitoTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Ashley Smith arrived at the facility unannounced to conduct a required annual visit at 10:10 a.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Yvette Feniquito and explained the reason for the visit.

The LPA, along with staff, 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: Knives are stored in a locked cabinet in the kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: The LPA observed the single-room bedrooms, which were furnished appropriately with clean linens, furnishings and sufficient lighting. There were four client bedrooms, one staff room, and one office. RESTROOMS: The two restrooms are clean, sanitary and in operating condition with grab bars and non-skid surfaces. The LPA observed appropriate hand-washing signs in the restrooms. COMMON SPACES: Walls and flooring were checked for cleanliness and good condition. The washer and dryer are next to the kitchen. Passageways were clean and clear of obstructions. No bodies of water were noted in the backyard. The LPA observed all the required postings that promoted cough etiquette, signs and symptoms of COVID-19, and appropriate hand hygiene. Medications are locked inaccessible in the kitchen cabinet.

INFECTION CONTROL: The facility has a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed an adequate supply of Personal Protection Equipment (PPE). The facility’s cleaning protocol is sufficient. The facility can designate a single isolation room if the facility has a confirmed case of COVID-19. The Administrator is up to date regarding policies around vaccinations, visitation, and the required updates needed for the facility's Plan of Operation. The facility’s policies and procedures as it pertains to infection control are adequate.

No deficiencies cited at this time. Exit interview conducted. Signatures obtained.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2022
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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