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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600690
Report Date: 05/21/2022
Date Signed: 05/21/2022 01:02:22 PM

Document Has Been Signed on 05/21/2022 01:02 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:THERAPEUTIC LIVING CENTERS FOR THE BLINDFACILITY NUMBER:
197600690
ADMINISTRATOR:HITZ, JADEFACILITY TYPE:
735
ADDRESS:17712 PARTHENIATELEPHONE:
(818) 349-3440
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 6CENSUS: 2DATE:
05/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Caretha MitchellTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness met with Lead House Service Coordinator Caretha Mitchell, to obtain further information for the complaint investigation, control # 31-AS-20200918170027, that was completed and delivered on 09/16/2021. Further information obtained revealed staff # 1 (S1) did leave the clients unsupervised, and was disciplined and re-assigned to the agencies other facilities.

Also the second incident that occurred at the facility, dated August 28, 2020 (correct date of incident), the final investigation by the facility, concluded, that the apple did not belong to facility staff. It was alleged, agency staff brought the laced apple with marijuana to the facility. It was later revealed, the (2) agency staff were terminated, and the agency never provided supervision assistance to the facility after the incident. Therefore, LPA has determined that based on the information obtained during today's visit, the incident/investigation has been concluded, and there is no additional follow up needed at this time.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2022
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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