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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600690
Report Date: 03/10/2025
Date Signed: 03/10/2025 01:59:18 PM

Document Has Been Signed on 03/10/2025 01:59 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:THERAPEUTIC LIVING CENTERS FOR THE BLINDFACILITY NUMBER:
197600690
ADMINISTRATOR/
DIRECTOR:		HITZ, JADEFACILITY TYPE:
735
ADDRESS:17712 PARTHENIATELEPHONE:
(818) 349-3440
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 6CENSUS: 3DATE:
03/10/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Tasha Davis- Staff TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Mariana Agban and Michael Cava conducted an unannounced Case Management visit to the facility. The purpose of today’s visit was to serve the Order of Immediate Exclusion from the Facility for Staff #1 (S1)

On today's visit LPAs met with staff, Tasha Davis and explained the reason for the visit. LPAs also spoke with the administrator, Joshua Cration over the telephone as he was unavailable during the visit. Administrator instructed Staff, Tasha Davis to receive and sign report on his behalf. Tasha was served an Immediate Exclusion Order for Staff #1(S1). No immediate Health and Safety Hazard was noted during this visit.

Exit interview held. A copy of the report was provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
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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