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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600178
Report Date: 12/17/2024
Date Signed: 12/17/2024 02:14:16 PM

Document Has Been Signed on 12/17/2024 02:14 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:VAGTHOL'S RESIDENTIAL CARE-HOMEWOODFACILITY NUMBER:
197600178
ADMINISTRATOR/
DIRECTOR:		VICTORIA BARRERAFACILITY TYPE:
735
ADDRESS:6561 HOMEWOOD AVE.TELEPHONE:
(323) 464-0637
CITY:LOS ANGELESSTATE: CAZIP CODE:
90028
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
12/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Victoria BarreraTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 1217/24, 8:35 am, Licensing Program Analyst (LPA) Raymond Comer, conducted an unannounced Annual visit to this facility. LPA met with Facility Administrator, Victoria Barrera and reason for the visit was discussed.

Facility is licensed as a single-story residence, fire clearance for six (6) non-ambulatory, developmentally disabled adults, 18-59. Facility has five (5) bedrooms; two private rooms, and two shared rooms, including one (1) designated staff room, and two (2) bathrooms.

At 8:50 am, LPA conducted a tour of the physical plant with the Administrator and observed the following:

Physical plant was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Room temperature is comfortable; wall thermostat displays a setting of 72.0°F; within the required range. An approved Mitigation and Infection Control plan is on file. Hand washing, and required signage are prominently displayed throughout the facility. Required postings observed to be current. Disaster drills were last conducted on November, 2024.

Fire Detection/Protection system is present in the facility. Multiple dual smoke alarm/ carbon monoxide senors are installed, hardwired, and interconnected. Smoke/Carbon monoxide detectors were tested and function properly. Three (3) fire extinguishers were observed; located in the kitchen area, laundry, and outside the garage. Extinguishers observed as full; last inspected on 11/18/24.

[LIC 809C-Continued]

Eva MillerTELEPHONE: (818) -596-4373
Raymond ComerTELEPHONE: 818-401-8655
DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: VAGTHOL'S RESIDENTIAL CARE-HOMEWOOD
FACILITY NUMBER: 197600178
VISIT DATE: 12/17/2024
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Kitchen: At 9:25 am, LPA observed kitchen as clean, equipped with a functional stove, multiple appliances, with food supply sufficiently stocked with at least two (2) days perishable, and seven (7) days non-perishable food. Frozen foods are wrapped and stored appropriately. Kitchen cabinets store dishes, plastic, paper goods and utensils. Knives and sharps are secured in a locked cabinet and inaccessible to residents. No chemicals or pesticides observed, nor accessible.

Medications: are stored in a locked kitchen cabinet, secured and inaccessible to residents. First Aid kit and manual are also stored in kitchen meds cabinet.



Laundry: At 10:15 am, LPA observed laundry area located in the hallway area, across from bedroom #2. Laundry soaps and other cleaning agents are secured and inaccessible to residents. LPA observed a storage cabinet containing towels, clean linen, and blankets appearing sufficient for residents.

Commons: LPA observed all common areas of the facility, including the living room and resident dining area. LPA observed common areas to be clean and organized. Furniture provides adequate seating for residents and is in good condition. Activities are observed in living room area and outdoor courtyard, with large television, electric piano, board games, puzzles etc.

Bedrooms: are observed as clean with sufficient lighting, properly furnished with sufficient closet space, bedding, linens, and adequate furnishings.

Bathrooms: were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 118.5°F. Within the required range. Towels and washcloths are not shared.

Garage: At 10:40 am, LPA toured the garage, which is detached from the house. LPA observed garage as locked and inaccessible to residents. Garage is used as storage for PPE supplies, stored emergency food supplies, bed liners, and other supplies for resident needs.

[LIC 809C-Continued]

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond ComerTELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: VAGTHOL'S RESIDENTIAL CARE-HOMEWOOD
FACILITY NUMBER: 197600178
VISIT DATE: 12/17/2024
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Outdoor: (backyard) At 11:15 am, LPA observed Courtyard area which maintains a shaded patio, a table, with sufficient seating for the residents. Outdoor furniture observed to be in good condition. All trash cans were observed to be covered. There are no bodies of water in the facility.

Resident records: At 11:40 am, Administrator office, located near the facility entrance, is locked and inaccessible to residents. A total of six (6) Resident files were reviewed for current Needs and Services plans, physician report, admission agreements and other pertinent documentation. Resident records appeared to be complete and current.



Staff records: Administrator office, located near the facility entrance, is locked and inaccessible to residents. A total of six (6) Staff files were reviewed. Physicians Record, First Aid/CPR, Criminal record clearances were present, and Staff are associated to this facility. Staff records appear to be complete and current.

There were no immediate health and safety hazards observed at the time of this inspection. Exit interview conducted and a copy of this report was given to the Administrator.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond ComerTELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC809 (FAS) - (06/04)
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