197603521-1-8-2024-31-AS-HRAI-CZAT3E-20240108132213

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603521
Report Date: 01/08/2024
Date Signed: 01/08/2024 01:23:08 PM

Document Has Been Signed on 01/08/2024 01:23 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:	TLC SUPPORT CENTER		FACILITY NUMBER:	197603521
ADMINISTRATOR:	SANDOVAL,JUAN		FACILITY TYPE:	775
ADDRESS:	7915 LINDLEY AVENUE		TELEPHONE:	(818) 708-1740
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY: 30		CENSUS: 11	DATE:	01/08/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Juan Sandoval, Administrator		TIME COMPLETED:	02:00 PM

NARRATIVE

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At approximately 10:15 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual inspection at the facility mentioned above. LPA met with Administrator, Juan Sandoval and disclosed the reason for the visit. LPA and Administrator toured the facility and the following was noted:

Entry: The front yard was well-maintained and surrounded by an unlocked gate. The facility monitored the premises with surveillance cameras at the front and sides of the building.

Kitchen: The kitchen contained a sink, a microwave, and a refrigerator. All areas were sanitary. The kitchen is not used for any cooking.

Bathrooms: The facility had 3 bathrooms. A Men’s Bathroom and a Women’s Bathroom were near the front entrance and had multiple stalls. A private bathroom was in the common area in the south side of the building. All bathrooms contained fully stocked liquid soap, paper towels, and trash cans. At 10:29 AM, water temperature tested in the Men’s Bathroom was 120 degrees Fahrenheit.

Common Activity Space: The facility is a Day Program which operates from 8:30 am to 2:30 pm.

The facility is on the second level located by the main office. LPA observed there to be one large open area in which program activities are provided. Furniture used is in good repair. LPA did not observe any obstructions or hazards. LPA observed exercise equipment which appears to be in adequate condition. Other equipment used for activities appears to be in adequate condition.
At 11:02 AM, the Fire extinguisher appear to be full and last serviced on 05/04/2023. Carbon monoxide detector is operational. Smoke detectors were hard-wired throughout the building, and fire sprinklers were installed throughout the building. The facility had first aid kits at the front entrance and in the southern common area. Facility temperature was maintained at 70 degrees F.
Continue on LIC 809C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TLC SUPPORT CENTER	FACILITY NUMBER: 197603521
	VISIT DATE: 01/08/2024

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Activities: Activity schedule was available upon request. LPA observed staff actively working with consumers.

Food Service: LPA toured the kitchenette area. There is a refrigerator which is not used for consumers. Consumers bring their own lunch and snacks which does not require refrigeration. .
If a client comes with no lunch then food will be offered to consumers and water is readily available.

Deficiency is issued per CA code of Regulations Title 22 or Health and Safety Code. See 809D's included with this report.

Appeal rights issued.

Exit interview conducted.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/08/2024 01:23 PM - It Cannot Be Edited

Created By: Huma Rahimi On 01/08/2024 at 12:58 PM

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: TLC SUPPORT CENTER	FACILITY NUMBER: 197603521
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82070(a)

82070(a) Client Records. The licensee shall ensure that a separate, complete, and current record is maintained in the facility and at the program site for each client. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in evelen (11) out eleveen (11) client's records which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/11/2024
	Plan of Correction
1 2 3 4	Administrator will update all client files so that they are current and up to date with required admissions agreements, physican reports, appriasals, etc. Admin. will contact LPA once completed. LPA will conduct a case management visit to ensure plan of correction was executed.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Nichelle Gillyard

LICENSING EVALUATOR NAME:

Huma Rahimi

LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

LIC809 (FAS) - (06/04)

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