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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191221487
Report Date: 06/05/2025
Date Signed: 06/05/2025 07:49:52 PM

Document Has Been Signed on 06/05/2025 07:49 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:
06/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Yvette FeniquitoTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 9:30 A.M. When the LPA arrived, there was one staff and one client present. The LPA was greeted by Caregiver Baby Valencia and informed the reason for the visit. Caregiver contacted the Administrator by phone, Yvette Feniquito. At 10:12 A.M. Administrator arrived at the facility; LPA explained the reason for the visit.

At 10:20 A.M. the LPA, along with 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. The following was observed:

The facility is vendored through North Los Angeles County Regional Center as a level 2 home. The Facility does handle cash resources for three (3) clients. Surety Bond is current.

Between 10:25 A.M. and 10:53 A.M. battery operated smoke alarms and single carbon monoxide detectors were tested and functioned properly. The fire extinguisher was observed to be fully charged and last purchased on 06/17/2024.

Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2025
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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Document Has Been Signed on 06/05/2025 07:49 PM - It Cannot Be Edited


Created By: Valeria Conway On 06/05/2025 at 02:48 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: 06/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above as the hot water temperature throughout the facility was measured above the required regulatory range which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2025
Plan of Correction
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During today's visit, the administrator adjusted the thermostat to ensure the temperature was within the regulatory range. As part of the POC staff will complete a weekly temperature log which will be submitted to the LPA by 06/12/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Desaree Perera
NAME OF LICENSING PROGRAM MANAGER:
Valeria Conway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/05/2025 07:49 PM - It Cannot Be Edited


Created By: Valeria Conway On 06/05/2025 at 02:48 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: 06/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85095.5(a)(2)(A)
Infection Control Requirements
(a) A licensee shall ensure that infection control practices are maintained as follows: (2) Environmental cleaning and disinfection activities shall be performed following the manufacturers' instructions for proper use of the cleaning and disinfecting products.  These activities shall be completed, at a minimum, as follows:  (A) Surfaces such as floors, chairs, toilets, sinks, counters and tabletops shall be cleaned and disinfected on a regular basis to ensure they are safe and sanitary.  These surfaces shall also be disinfected when these surfaces are contaminated and visibly soiled with blood or body fluids or other potentially infectious material. 

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations], the licensee did not comply with the section cited above by having soiled floors and unsanitary bathrooms at the time of the visit which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2025
Plan of Correction
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Administrator agreed to provide photographic documentation confirming that the bathrooms and house floors have been cleaned before POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Desaree Perera
NAME OF LICENSING PROGRAM MANAGER:
Valeria Conway
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2025


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: FENIQUITO RESIDENTIAL CARE
FACILITY NUMBER: 191221487
VISIT DATE: 06/05/2025
NARRATIVE
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Continued from LIC 809-C

BEDROOMS: The facility consists of four (4) private client bedrooms and one (1) designated for staff use. LPA observed all client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

RESTROOMS: Two (2) shared restrooms are designated for clients, staff and visitors. Restrooms were observed to be in an unsanitary condition. Hot water was checked in both restrooms and measured over the required range. Restroom next to the dining area measured 121.4-degree Freiheit (F*) and hallway restroom measured at 122.7 F*. The LPA observed appropriate hand-washing signs in the restrooms.

KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. LPA conducted a review of expiration dates on product labels. The LPA observed that two (2) items were past their expiration date. Administrator discarded items during today’s visit. Technical Advice Issued.


At 10:45 A.M. hot water measured at 124.4 degrees Fahrenheit. The kitchen floor, stove and surrounding surfaces were visibly soiled. All medications are securely stored in a locked cabinet located to the left and above the kitchen sink, ensuring they remain inaccessible to clients in care. Although knives are designated to be stored in a locked cabinet, it was observed during today’s visit that the cabinet lock was not secured. Administrator secured knives by properly locking the cabinet.

COMMON SPACES: Walls and flooring were checked for cleanliness and good condition. At the time of the visit dining room floors were visible soiled. The LPA observed all the required postings in the common area. LPA observed cameras in the common area, the backyard and the front yard. The facility maintained a comfortable temperature of 73 degrees.

LAUNDRY ROOM: Washer and dryer were observed adjacent to the kitchen. All chemicals’ supplies were locked an inaccessible to clients in care. Extra cleaning supplies and a first aid kit were observed in a locked closet in front of the washer and dryer.

Continued from LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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: FENIQUITO RESIDENTIAL CARE
FACILITY NUMBER: 191221487
VISIT DATE: 06/05/2025
NARRATIVE
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Continued from LIC 809-C

OUTDOOR SPACE: The backyard has a covered outdoor area equipped with furniture for clients’ use. All exits and passageways were observed to be free of hazards. There were no bodies of water noted at the time of the visit. Facility has one side gate. LPA observed a side gate to be self-latching and closing with clear passageways for emergency exit use. LPA observed a detached studio on the premises. The studio was secured with a keypad lock. Upon entry, LPA observed that the space was being used as the administrator’s office and for storage of extra supplies.

GARAGE: The garage is detached to the house. Garage was observed to be locked. LPA observed a freezer and a fridge containing extra food for clients and staff use. Additionally, garage is used as storage of decoration, furniture and extra supplies.

CLIENT FILES: Beginning at 12:24 P.M., LPA reviewed all four (4) client files for, but not limited to: physician's report, proof of TB test, Admission Agreement, and cash resources. All client files reviewed were complete and contained all documentation required. LPA observed that two (2) clients currently residing in the facility are over the age of 60. LPA advised the administrator to submit an age exception request to Community Care Licensing (CCL), documenting that the Adult Residential Facility (ARF) is the most appropriate setting to meet the needs of these individuals.

STAFF FILES: Beginning at 1:25 P.M., LPA reviewed three (3) staff files for, but not limited to: fingerprint background clearance, health screening, TB test, and training records. All three (3) staff files reviewed were in compliance with regulation.

MEDICATION REVIEW: Beginning at 2:00 P.M., LPA reviewed medications for four (4) clients. All medications reviewed were documented and stored in compliance with regulation.

Continued from LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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: FENIQUITO RESIDENTIAL CARE
FACILITY NUMBER: 191221487
VISIT DATE: 06/05/2025
NARRATIVE
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Continued from LIC 809-C

LPA requested the following documents: Personnel Record LIC 500, Register of facility Clients/Residents LIC 9020, Liability Insurance and Surety Bond. Emergency disaster drills are conducted monthly, with the last drill conducted on 06/01/2025. The facility’s policies and procedures as it pertains to infection control are adequate.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 9099-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties.

Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
LIC809 (FAS) - (06/04)
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