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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600690
Report Date: 12/11/2023
Date Signed: 12/11/2023 12:58:49 PM

Document Has Been Signed on 12/11/2023 12:58 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 S.RO, 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: 4DATE:
12/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Thosa DavisTIME COMPLETED:
01:43 PM
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At 09:45 a.m. Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. LPA was met by Tina Harris (one-on-one staff for one of the clients). LPA asked to speak to the administrator/licensee. The administrator-Joshua Cration was called by Thosa Davis, the House Service Coordinator.

Upon entry, LPA’s temperature was taken at the door before entry. LPA observed covid infection control signs at the entrance of the facility. In addition, there was Rights of Individuals, activity schedule, staff schedule, disaster plan, house rules, grievance policy and client rights signs.

LPA asked for the census, client and staff files before the physical plant tour. The physical plant tour started at 10:45 a.m.
Kitchen area was observed to be clean. LPA reviewed the food service area, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the four (4) clients currently residing there. There is an excess of perishables in several of the cabinets. Sharps observed to be stored, locked, and secured in one of the cabinets to the right of refrigerator observed to be inaccessible to clients. The fire extinguisher is in the kitchen area and is fully charged, reading March 2023. There is a carbon monoxide detector in the kitchen area against the wall.

There is another carbon monoxide detector located against the wall in the middle of the one of the bathrooms, laundry area and staff/office room. There is smoke detectors located in different areas of the house and were tested and functional.

LIC 809-C continued
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2023
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: THERAPEUTIC LIVING CENTERS FOR THE BLIND
FACILITY NUMBER: 197600690
VISIT DATE: 12/11/2023
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Laundry room is accessible through one of the activity areas leading to the garage which is locked an inaccessible to the clients. There is one washer and dryer in the laundry area. The toxins are kept in the garage in a cabinet and locked.

Garage is attached from within the house (laundry room): used to store excess incontinence. There is also another refrigerator located in the garage area with extra food and there is a freezer with extra food.

Medications are in the staff/office room locked and secured in a plastic cabinet. Medication storage observed to be locked and inaccessible to clients. The first aid kit and manual are in this plastic cabinet area.


Bedrooms: There is three (3) client bedrooms. One is shared with two (2) clients. The other room is single, use. The last room has two beds but is being used as a single, person and has a private bathroom. There is a bathroom next to the bedroom three. There is a staff room with a private bathroom. Next to the staff room is another fire extinguisher which is fully charged, reading March 2023. The bathrooms read a temperature between 113.00 and 166.4 Fahrenheit.

There is two pantry areas in the hallways. One of the pantries is filled with emergency food supply buckets, extra gloves and masks and bottles of water. The second pantry is filled with extra blankets and towels for the clients.

Backyard: There is a large patio table set with umbrella and chairs for clients use. There is enough seating for four (4) clients. There is no pool at this facility.

Living and dining room furniture is accessible for four (4) clients. There is a television and enough seating for four clients. There is internet accessibility a phone line available for client use. Furniture was observed to be in good condition and the fireplace has a covering around it.

Temperature of facility wall thermostat is observed and set to 70 degrees Fahrenheit.



An exit interview was conducted, no citations were issued, and a copy of this report was given to the house service coordinator designated by the administrator.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023
LIC809 (FAS) - (06/04)
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