195850321-2-4-2025-29-AS-ABAN-DDKSFT-20250204125051

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850321
Report Date: 02/04/2025
Date Signed: 02/04/2025 12:51:13 PM

Document Has Been Signed on 02/04/2025 12:51 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:	OPI STR		FACILITY NUMBER:	195850321
ADMINISTRATOR/ DIRECTOR:	FIGUEROA, PAUL		FACILITY TYPE:	772
ADDRESS:	6123 WOODLAKE AVE		TELEPHONE:	(818) 572-0607
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY: 6		CENSUS: 5	DATE:	02/04/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:27 AM
MET WITH:	Paul Figueroa		TIME VISIT/ INSPECTION COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 10:27AM. LPA met with Clinical Director Brittany Austin-Cook and explained the reason for the visit. Residential Manager Janet Tuverson, Executive Director Jessica Breton, and Administrator/Program Director Paul Figueroa arrived during the visit. Beginning at 10:30AM, the LPA, along with the Clinical Director toured the physical plant areas inside and outside to ensure there are no health and safety hazards. The following was observed. KITCHEN: LPA toured the kitchen at 10:30AM. Kitchen appliances were clean and in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Knives and cleaning solutions were stored locked and inaccessible in a drawer and under the sink. Foods were labeled and checked for expiration dates. BEDROOMS: There are three (3) bedrooms for shared-use. LPA observed client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. There is no staff bedroom on premises. RESTROOMS: The facility has four (4) restrooms total. Two (2) are for client-use; one (1) is attached to bedroom #3 and one (1) is in the hallway for shared client-use. Two (2) are for staff use and kept locked; one (1) is downstairs and one (1) is upstairs. Client restrooms were relatively clean and sanitary and in operating condition with slip-resistant materials. At 10:40AM, hot water in client restrooms measured high at 128.9 and 133.9 degrees Fahrenheit. Water heater was lowered and at 11:11AM, LPA remeasured hot water at 115.7 and 118.2 degrees F, which is within the required range. Report continued on LIC 809-C.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

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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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: OPI STR	FACILITY NUMBER: 195850321
	VISIT DATE: 02/04/2025

NARRATIVE

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LAUNDRY/GARAGE: Locked laundry room is located on the ground floor. Laundry supplies were observed inside the locked laundry room. The locked garage was observed to contain locked chemical storage, emergency food and water, as well as activity and other supplies. Additional refrigerator and freezer were observed in the garage.
COMMON AREAS: The facility is a two-story home, consisting of an upstairs and a downstairs area. There are no common areas upstairs. Downstairs common areas include a living room, study, and dining area. All furniture appeared clean and in good condition. A dual-sided fireplace in the study/dining room, and separate fireplace were observed in the living room and an additional fireplace in the upstairs office; all fireplaces were observed to be adequately screened at the time of the visit. The LPA observed the fire extinguishers to be fully charged and last serviced on 11/26/2024. Required postings are posted throughout facility to promote handwashing, and cough/sneeze etiquette. At 11:08AM, combination smoke detector(s) and carbon monoxide detector were tested and were operational at the time of the visit.
TREATMENT/THERAPY, MEDICATION ROOM & OFFICE AREAS: Upstairs rooms were observed to remain locked at all times, and accessible to clients when they are with staff. Upstairs consists of two (2) office areas and a group therapy room. Downstairs contains a locked nurse/staff office, which contained a locked medication closet. At 10:49AM, medications were reviewed for two (2) clients. Medications observed were properly labeled and medication records observed were documented per regulation, no errors observed. The Offices are kept inaccessible to clients unless properly supervised.
SURROUNDING GROUNDS: The Front Yard includes a driveway, paved walkways and landscaped areas. The backyard is fenced and includes both paved and landscaped areas, a patio, furniture appropriate for outdoor use, an in-ground swimming pool and separate in-ground hot tub. The pool is kept inaccessible to clients with the use of fencing that includes a locked gate. The hot tub contains a locked cover. Staff have received the appropriate Water Safety Certification and Administrator stated that qualified staff are present at all times that the pool or hot tub is in use by clients. No immediate hazards were observed during the visit.

RECORD REVIEW: Beginning at 11:20AM, LPA reviewed five (5) out of five (5) client and four (4) personnel files for documents including but not limited to: medical records, care plans, Admission Agreement, TB test, health screening, staff training and fingerprint clearance. All client and personnel files were in order.INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency drills are conducted monthly, with the last drill conducted on 01/17/2025.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

LIC809 (FAS) - (06/04)

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