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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607632
Report Date: 04/05/2022
Date Signed: 04/05/2022 10:57:36 AM

Document Has Been Signed on 04/05/2022 10:57 AM - 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:VICKY RESIDENTIAL HOME CAREFACILITY NUMBER:
197607632
ADMINISTRATOR:VICTORIA C. TORRESFACILITY TYPE:
735
ADDRESS:16521 MCKEEVER STREETTELEPHONE:
(818) 360-2174
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 4CENSUS: 3DATE:
04/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:Victoria Torres/ AdministratorTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility and was greeted by facility staff. LPA explained the reason for the visit and the administrator was called. The administrator arrived a short while later. The LPA's temperature and all covid precautions were taken prior to allowing the LPA into the home.

The LPA was able to briefly tour the home for any immediately health and safety concerns. The smoke detectors and carbon monoxide detectors were tested and functioned properly. The fire extinguisher was last serviced on 2/21/22.

The facility is currently following their mitigation plan and no deficiencies were observed.

Exit interview was conducted and report issued.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2022
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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