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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606335
Report Date: 12/11/2023
Date Signed: 12/11/2023 04:08:41 PM

Document Has Been Signed on 12/11/2023 04:08 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:HILLVIEW RESIDENTIAL CENTER, BUILDING CFACILITY NUMBER:
197606335
ADMINISTRATOR:JACK AVILAFACILITY TYPE:
735
ADDRESS:12408 VAN NUYS BLVD., BUID. CTELEPHONE:
(818) 896-1161
CITY:PACOIMASTATE: CAZIP CODE:
91331
CAPACITY: 15CENSUS: 9DATE:
12/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator Nicole SosaTIME COMPLETED:
01:35 PM
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At 08:30 AM Licensing Program Analyst (LPA) Christopher Alemoh conducted a required annual visit to facility. LPA met with Nicole Sosa explained the purpose of the visit. LPA’s temperature was checked and Covid signs are posted on the front door of the unit. At the time of visit there was nine residents present and two staff on-duty.

LPA began physical plant at 08:50AM.

Fire extinguisher: There are four (4) extinguishers all over the facility, one (1) in the kitchen, one (1) in the hallway in between bedrooms and the other two are in resident hallways.. Extinguishers were observed to be operable and last inspected on 12/08/2024. Smoke and carbon monoxide alarms are tested and observed to be operable.

Laundry room is located in the bedroom hallway. Cleaning solutions and laundry detergents are observed kept in the locked cabinet in the locked laundry room.

Medication was observed to be inaccessible and stored in a secured cabinet in the staff office. There is a complete First Aid kit attached to the medication cabinet.

Record Review, In addition to staff and client record review, facility records were also checked for insurance liability and vehicle maintenance all required documents and signatures were present.

Living and dining room furniture were noted and in use. This common area was observed to be in good condition.

Bathrooms were observed to be clean and sanitary with necessary supplies. Hot water temperature measured at a range of 116.6-118.9°F and within the required range. Proper hand washing signs are posted in every restroom.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
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: HILLVIEW RESIDENTIAL CENTER, BUILDING C
FACILITY NUMBER: 197606335
VISIT DATE: 12/11/2023
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Kitchen area was observed to be clean and sanitary. All the toxins, cleaning solutions and disinfectants are locked in the maintenance room that could only be accessed by maintenance staff. Food: The facility is observed to have sufficient food supply for the clients both perishable and non-perishable. All the food however are being prepared off site and just brought to the facility.

No Deficiencies Cited.

Exit interview conducted and a copy of this report was given.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
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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