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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607892
Report Date: 11/27/2024
Date Signed: 11/27/2024 12:39:22 PM

Document Has Been Signed on 11/27/2024 12:39 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:CHRISTINE'S RETREATFACILITY NUMBER:
197607892
ADMINISTRATOR/
DIRECTOR:		GEVORG MKRTCHIANFACILITY TYPE:
735
ADDRESS:14712 KILLION STREETTELEPHONE:
(818) 387-8572
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91411
CAPACITY: 6CENSUS: 4DATE:
11/27/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:26 AM
MET WITH:Marsha WilliamsTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 09:26 AM to conduct an unannounced Case Management visit at the facility today. LPA met with facility staff who contacted the facility backup Administrator Marsha Williams. The facility backup Administrator arrived at approximately 11:30 AM. The LPA advised the backup Administrator of the reason for the visit.

During the physical plant tour the LPA observed the facility’s emergency exit gate to be obstructed by a bar containing hanging laundry left out to dry. This bar and the laundry made the emergency exit gate inaccessible in the event of an emergency which poses an immediate health and safety risk to residents in care. This is a zero-tolerance violation and an immediate civil penalty of $500 is being assessed.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiency and was cited and civil penalty assessed. (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE: DATE: 11/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/27/2024
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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Document Has Been Signed on 11/27/2024 12:39 PM - It Cannot Be Edited


Created By: Trevor Byrne On 11/27/2024 at 12:20 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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CHRISTINE'S RETREAT
FACILITY NUMBER: 197607892

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/27/2024
Section Cited
CCR
80020(a)

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80020 Fire Clearance
(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.
This requirement is not met as evidenced by:
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Facility staff removed the bar and clothing at the time of the visit POC cleared.
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Based on observation the licensee did not comply with the section cited above as the facility's emergency exit gate was obstructed by a bar with clothes hanging to dry which poses an immediate safety risk to clients in care.
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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:Kasandra Lopez
LICENSING EVALUATOR NAME:Trevor Byrne
LICENSING EVALUATOR SIGNATURE:
DATE: 11/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/27/2024


LIC809 (FAS) - (06/04)
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