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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600690
Report Date: 10/04/2024
Date Signed: 10/04/2024 12:11:07 PM

Document Has Been Signed on 10/04/2024 12:11 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: 4DATE:
10/04/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Caretha MitchellTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
NARRATIVE
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 Licensing Program Analyst (LPA) Mariana Agban conducted an announced plan of correction visit. LPA met with House Manager Caretha Mitchel and explained the reason for the visit. The purpose of the plan of correction visit is to ensure that the deficiency issued during a complaint on 06/20/2024 is corrected. At 11:00 AM, LPA conducted a physical plan tour, to ensure the health and safety of the clients are protected and are in compliance with Title 22 Regulations. On 09/24/24 an Informal Conference was conducted with Administrator Joshua Cration and QIDP Latoya Glover in the Woodland Hills Adult and Senior Care Regional office. LPA Agban had reissued the citation with POC date of 09/26/2024, however, as of today 10/04/24, the POC was not cleared. Therefore, a civil penalty is issued for failure to correct the violation, and a new LIC 809 D is created with a new Plan of correction (POC) date. Administrator was contacted and LPA was informed that all required documents will be submitted promptly.

Exit interview conducted, appeal rights given and a copy of this report signed and delivered.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2024
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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Document Has Been Signed on 10/04/2024 12:11 PM - It Cannot Be Edited


Created By: Mariana Agban On 10/04/2024 at 11:26 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: 10/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/05/2024
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 agreed to provide supportive documents by the POC date.
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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. Based on information obtained Licensee did not follow eviction procedures by providing supportive documents requested.
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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: 10/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2024


LIC809 (FAS) - (06/04)
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