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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607943
Report Date: 11/01/2022
Date Signed: 11/14/2022 09:54:16 AM

Document Has Been Signed on 11/14/2022 09:54 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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:VIRGINIA CATALINA LLCFACILITY NUMBER:
197607943
ADMINISTRATOR:KEVIN SCANLANFACILITY TYPE:
735
ADDRESS:7000 MORSE AVENUETELEPHONE:
(818) 394-9878
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 4CENSUS: 4DATE:
11/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Kevin ScanlanTIME COMPLETED:
01:28 PM
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On 11/01/2022, Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. This annual inspection had an emphasis on infection control practices, and procedures. The LPA spoke with the administrator Kevin Scanlan, and explained the reason for the visit.

From 10:30 a.m. to 12:00 p. m, the LPA, and administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations.

KITCHEN: Kitchen appliances were in operable condition. Kitchen knives and medications were locked in a kitchen cabinet. There was sufficient perishable food for four residents, and the caregiver.

BEDROOMS: The residents’ bedrooms were clean, furnished appropriately with linens, appropriate furnishings, and sufficient lighting.

RESTROOM: Restrooms are clean, sanitary, and in operating condition. The bathrooms were observed with appropriate signs. Hand washing signs were posted in the bathrooms.

COMMON SPACES: The living room , and dining area furniture, walls, and flooring were observed to be in good condition. The LPA observed sanitizer interspersed throughout the facility.

OUTDOOR: The backyard has outdoor sitting, and a patio umbrella to provide shade. The garage sliding gate is kept unlocked. There are no open bodies of water.

INFECTION CONTROL: During today’s visit, the LPA spoke with the administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. Required postings were observed at the entry point.

Exit interview conducted with administrator. Signature were obtained. Report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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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