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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600690
Report Date: 09/24/2024
Date Signed: 09/24/2024 11:09:58 AM

Document Has Been Signed on 09/24/2024 11:09 AM - 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: 4DATE:
09/24/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Joshua CrationTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
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An Informal Conference was conducted today in the Woodland Hills Adult and Senior Care Regional office. The purpose of this Informal Conference is to discuss the incident that occurred during June 2024

Present at today's meeting are the following:
Eva Miller, Licensing Program Manager (LPM)

Mariana Agban, Licensing Program Analyst (LPA)

Xochitl Aragon, Community Services Supervisor – QA

Ari Stark Community Service Specialist

Joshua Cration- Facility Administrator

Latoya Glover - QIDP

BRIEF HISTORY: The facility has been in operation since licensure on 05/24/96 and is licensed for six ambulatory developmentally disabled adults.

On 6/12/24 Complaint 31-AS-20240612122942 was received by the Woodland Hills Adult & Senior Care Regional Office alleging unlawful eviction to Client1 (C1). On 6/20/24 LPA Mariana Agban conducted an initial complaint visit and substantiated the allegation of unlawful eviction. The facility was cited on 6/20/24 and Administrator agreed to review regulations regarding eviction procedures and to submit a written certification that eviction procedures will be followed. Administrator also agreed to issue a 30-day notice to Client 1 and request a 3-day eviction approval from the CCLD Woodland Hills Office. (Continue 809 C)

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: THERAPEUTIC LIVING CENTERS FOR THE BLIND
FACILITY NUMBER: 197600690
VISIT DATE: 09/24/2024
NARRATIVE
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The facility was given until 06/27/24 to clear the citation, however, as of today 09/24/2024 citation was not cleared. At today’s meeting Licensing team and Regional Center representatives discussed issuing a new 30-day notice to Client 1 (C1) as of today. On 09/24/24 LPA is reissuing the citation with a new POC date. LPA Agban also expressed concerns regarding unreported incidents at the facility this year. Administrator was advised to send all incident reports (SIRs) to LPA Agban with the updated and revised 30-day eviction notice.

Exit interview conducted, citation reissued and copy of this report delivered.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
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Document Has Been Signed on 09/24/2024 11:09 AM - It Cannot Be Edited


Created By: Mariana Agban On 09/24/2024 at 10:54 AM
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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: THERAPEUTIC LIVING CENTERS FOR THE BLIND
FACILITY NUMBER: 197600690

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2024
Section Cited
CCR
87224(a)

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Eviction Procedures. The licensee may, upon thirty (30) days written notice to the resident, evict the resident for nonpayment of the rate for basic services, failure to comply with state or local law,
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Administrator will review regulation regarding eviction procedures. Administrator agreed to submit a written certification that eviction procedures will be followed.
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 failure to comply with the general policies of the facility, development of a need not previously identified, and/or a change of use of the facility
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Type B
09/26/2024
Section Cited
CCR87224(b)

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87224(b) Eviction Procedures. The licensee may, upon obtaining prior written approval from the licensing agency, evict a resident upon three (3) days written notice to quit. Based on information obtained, the licensee did not comply with the section cited above.
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Administrator will issued 30 day notice to Client 1 and submit a copy to CCLD Woodland Hills Office by the POC date.
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 Client 1 was taken to the hospital by LAPD and placed on 5150 hold.Administrator did not issue 30 day or 3 day eviction to CCL and refused to accept client back from the facility. This poses a potential Haealth, Saftey, or Prsonal Rights risk to persons in care
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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.
SUPERVISOR'S NAME:Eva Miller
LICENSING EVALUATOR NAME:Mariana Agban
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024


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