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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191221487
Report Date: 06/24/2024
Date Signed: 06/24/2024 01:44:02 PM

Document Has Been Signed on 06/24/2024 01:44 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:FENIQUITO RESIDENTIAL CAREFACILITY NUMBER:
191221487
ADMINISTRATOR/
DIRECTOR:
YVETTE FENIQUITOFACILITY TYPE:
735
ADDRESS:12933 WELBY WAYTELEPHONE:
(818) 220-8248
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 4CENSUS: 4DATE:
06/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:44 AM
MET WITH:Yvette Feniquito, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
NARRATIVE
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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and was eventually let into the home by Yvette Feniquito, Administrator at 10:08am. The reason for today's visit was explained.

The facility is a single family home consisting of a living room, dining room, a kitchen, 4 bedrooms, a staff room, 2 full bathrooms and a detached garage. The home was originally fire cleared for 6 AMBULATORY residents. A wall was added to bedroom #4 to create a fifth bedroom for staff use. No permits were obtained to add the wall and no new fire clearance was requested. However, the Licensee did obtain a letter from the Department of Building and Safety indicating that a permit and a new fire clearance was not needed and signed by Engineer Robert T. Mayer. A copy of this letter was obtained on today's visit. The facility is vendorized by the North Los Angeles County Regional Center

The following domains were reviewed on today's visit due to time constraints:
Infection Control, Operational Requirements, Staff and Client Rights Information.

Per review of the domains, the facility provides internet access but does not have any internet access device
that can support real time interactive applications, equipped with video conferencing technology, including microphone and camera functions dedicated to client use. The facility also does not have a facility policy to allow shared access to all clients in the facility.

Deficiencies cited under Health and Safety Code, Chapter 3 California Community Care Facilities Act, Article 3 Regulations.
Exit interview was conducted, Appeals Rights Discussed and a copy was given.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2024
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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Document Has Been Signed on 06/24/2024 01:44 PM - It Cannot Be Edited


Created By: Christine Yee On 06/24/2024 at 01:22 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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FENIQUITO RESIDENTIAL CARE

FACILITY NUMBER: 191221487

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 06/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1537.1(a)
Regulations
(a) A licensee of a residential facility serving adults that has internet service shall provide at least one internet access device, such as a computer, smart phone, tablet, or other device, that can support real-time interactive applications, is equipped with videoconferencing technology, including microphone and camera functions, and is dedicated for client use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above as the facility does not currently have any internet access device that supports real time interactive applications equipped with videoconferencing technology including microphone and camera functions dedicated for client use which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2024
Plan of Correction
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The Licensee will ensure that an internet access device that meets Title 22 requirements is obtained and made available to the clients in care by 7/1/24.
Type B
Section Cited
HSC
1537.1(b)(2)
Regulations
(b) A licensee shall ensure the following requirements are met in providing any internet access device for client use: (2) The device shall be made available to clients in a manner that permits shared access among all clients in the facility during reasonable hours.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above as the facility does not have a facility plan in place to permit shared access among the clients in the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2024
Plan of Correction
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The LIcensee will develop a facility plan that will permit shared access among the clients in the facility during reasonalbe hours.
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:Kristin Heffernan
LICENSING EVALUATOR NAME:Christine Yee
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2024


LIC809 (FAS) - (06/04)
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