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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606869
Report Date: 11/09/2022
Date Signed: 11/09/2022 02:34:06 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/09/2022 02:34 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:TYCOON RESIDENTIALFACILITY NUMBER:
197606869
ADMINISTRATOR:YOLANDA VILLANUEVAFACILITY TYPE:
740
ADDRESS:10204 GERALD AVENUETELEPHONE:
(818) 363-3418
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 6CENSUS: 4DATE:
11/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Yolanda Villanueva TIME COMPLETED:
02:45 PM
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On 11/09/22 Licensing Program Analysts (LPAs) Joscelyn Martinez and Melissa Ruiz arrived at the facility to conduct an unannounced annual inspection. Upon arrival LPA met Licensee/Administrator Yolanda Villanueva and the purpose of the visit was explained.

At 10:10 a.m. LPAs conducted a physical tour of the facility. Infection Control: Covid-19 infection control signage were observed outside of the facility. Proper signage was also observed inside in the common areas. Upon entrance, administrator took LPA’s temperature and was asked to sign-in the visitor’s log. Facility has sufficient PPE supplies for more than 30 days. Food Inspection: LPAs observed there was sufficient stock of one-week non-perishable foods and two-day perishable foods. Sharps and medications are centrally stored in a locked area. Garbage can has a tight-fitting lid in the kitchen. Fire extinguisher has a purchase date of 04/22/2022. Common Areas: All common areas were observed to be clean and properly furnished. Facility maintains a comfortable temperature of 74.0 F. Facility has an attached garage which can be accessed from the living room and the outside. Garage is utilized for supply storage; washer and dryer machine. Residents Rooms: There are four (4) bedrooms of which one (1) is designated for staff use. All the four (4) bedrooms were toured and appear to be clean and properly furnished. LPA observed additional bedding and linens sufficient for all of the residents. Bathrooms: There are two (2) bathrooms in the facility. LPA observed all bathrooms to have grab bars and non-skid mats. Outside areas: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water on the ground.

No deficiences cited. Report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2022
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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