197607632-3-27-2024-31-AS-GSAO-D3RP5X-20240327110129

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607632
Report Date: 03/27/2024
Date Signed: 03/27/2024 11:01:56 AM

Document Has Been Signed on 03/27/2024 11:01 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	VICKY RESIDENTIAL HOME CARE		FACILITY NUMBER:	197607632
ADMINISTRATOR:	VICTORIA C. TORRES		FACILITY TYPE:	735
ADDRESS:	16521 MCKEEVER STREET		TELEPHONE:	(818) 360-2174
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY: 4		CENSUS: 4	DATE:	03/27/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Ronald Barit		TIME COMPLETED:	11:15 AM

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On 03/27/24 at 08:20AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with caregiver Leonida Cahayon and disclosed the purpose of the visit. Ronald Barit, the administrator arrived about ten (10) minutes later.

LPA asked for the census, client, and staff rosters. A physical tour was conducted at 09:10 AM and observed the following:

The Kitchen area was toured, and LPA observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. There is extra canned goods and cereal in the kitchen pantries. On the right side of the sink the knives are kept locked and inaccessible to the clients. There are cleaning supplies under the kitchen sink locked and inaccessible to the clients. There is a seven (7) day food menu on the refrigerator. The medication and first aid kit is on the left-side of the kitchen locked and inaccessible to the clients. There is an entry to the office on your left-hand side of the kitchen. The office has a small refrigerator for staff and client/staff files.

Outside/Backyard: The outside/backyard has furniture for the clients with proper seating. The facility does have a signal system. The facility does not have a pool/body of water. The outside/backyard can be accessed from the dining/living room area. The washer and dryer are located outside with the chemicals on two top shelves locked and inaccessible to the clients.

There is a garage that is detached which contains extra incontinence and beds. There is also a shed outside that contains client property.

LIC 809C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

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: VICKY RESIDENTIAL HOME CARE	FACILITY NUMBER: 197607632
	VISIT DATE: 03/27/2024

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Bedrooms: There are five (5) bedrooms and two (2) full bathrooms. All four (4) bedrooms are single, occupied for clients. There is a staff room. All bedrooms and bathrooms were toured and were properly furnished and have appropriate bedding, linens, toiletry, and lightning. The bathrooms have proper toiletry, grab bars and non-skid mats. The bathroom temperatures of the water are within regulations reading at 115–118-degree Fahrenheit.

The dining/living room area has enough seating for the clients and the staff. There is a fireplace that is covered and inaccessible to the clients. The dining room area has a television and internet access. The fire extinguisher is located against the wall on your right-hand side. It is fully charged. The expiration date is 02/2025.

The house temperature is at 68-degree Fahrenheit.

There are several smoke detectors/carbon monoxides in the dining/living area that are operable.

Administrative: There is no annual fee that is due right now. At the entrance of the facility against the wall there are signs: Administrator License, Yes, Emergency/Disaster Plan, Personal Rights, Planned Activity, Staff Schedule, Infection Control, Home Rules and Rights of Individuals with Developmental Disabilities. The last fire drill was 03/16/2024.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

LIC809 (FAS) - (06/04)

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