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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600306
Report Date: 03/13/2024
Date Signed: 03/13/2024 04:08:26 PM

Document Has Been Signed on 03/13/2024 04:08 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:ACTIVITIES FOR RETARDED CHILDREN AND ADULTSFACILITY NUMBER:
197600306
ADMINISTRATOR:CAROLE-ANN SCOTTFACILITY TYPE:
775
ADDRESS:6456 WHITSETT AVE.TELEPHONE:
(818) 762-4365
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 36CENSUS: 33DATE:
03/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Corrine Botte, Operations ManagerTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the entire CARE Inspection Tool and met with Corrine Botte, Operations Manager. Jennifer Pippard, Executive Director was not present on today's visit. The reason for today's visit was explained.

The facility is a two storey building consisting of a large activity room, living room, arts and crafts room, dining room, library, a bathroom, break room and kitchen on the first floor. The second floor consists of 3 offices, a computer room and a bathroom. There is also a detached garage on the premises. The facility is fire cleared for AMBULATORY clients only and is vendorized by the North Los Angeles Regional Center.

On today's visit, LPA Yee reviewed the following six domains: Infection Control, Operational Requirements, Staffing, Clients Rights - Information, Food Service and Incidental Medical Services. Per review of the 6 domains, no deficiencies were noted or cited on today's visit.

Due to time constraints, the remaining 6 domains will be reviewed on a return visit.


Exit interview was conducted.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2024
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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