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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607943
Report Date: 12/02/2025
Date Signed: 12/02/2025 04:17:12 PM

Document Has Been Signed on 12/02/2025 04:17 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:VIRGINIA CATALINA LLCFACILITY NUMBER:
197607943
ADMINISTRATOR/
DIRECTOR:		KEVIN SCANLANFACILITY TYPE:
735
ADDRESS:7000 MORSE AVENUETELEPHONE:
(818) 394-9878
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 4CENSUS: 4DATE:
12/02/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:17 AM
MET WITH:Kevin ScanlanTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 10:17 AM. LPA contacted the facility Administrator Kevin Scanlan via telephone call. The Administrator arrived to the facility at 10:56 AM Entrance interview conducted and the reason for the visit was explained.

Beginning at 10:57 AM, the LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

BEDROOMS: There are five (5) bedrooms in the facility; four (4) are designated for resident use and one (1) is designated as a staff room. All four (4) resident bedrooms are private rooms. LPA and the Administrator toured all four (4) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. The staff room was observed to be locked and inaccessible to clients in care.

BATHROOMS: There are two (2) bathrooms at the facility. Both are designated as common resident bathrooms. Both bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. All grab bars were observed to be in good repair and were properly secured. The water temperature was measured in both bathrooms between 107.8 degrees Fahrenheit and 117.1 degrees Fahrenheit which is in compliance with regulation.

Continued on LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VIRGINIA CATALINA LLC
FACILITY NUMBER: 197607943
VISIT DATE: 12/02/2025
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COMMON AREAS: This includes the living room, dining room, office area, laundry room, and hallway. LPA observed the living room to be clean and properly furnished at the time of the visit. LPA observed the living room to contain an appropriately screened fireplace, chairs, and activities for resident use. The dining room was observed to be clean and contained an appropriately screened fireplace and adequate seating for resident use. Additionally, the dining room contained a secured storage closet which contained resident files. LPA observed the office area to contain required facility postings. LPA observed the facility laundry room adjacent to the kitchen. The laundry room was observed to contain a washer and dryer and a properly secured cabinet which contained detergents and other cleaning supplies. LPA observed a wall mounted fire extinguisher in the laundry room to be fully charged and serviced on 06/04/2025. The hallway was observed to contain a set of cabinets which contained extra linens and a closet which contained cleaning tools. Cameras were observed in the dining room and the living room. LPA confirmed with the Administrator that audio is not recorded. Smoke detectors and carbon monoxide detectors were tested at 11:18 AM and were functional at the time of the visit.

OUTDOOR SPACE/GARAGE: The facility has one (1) emergency exit gate, LPA observed clear passageways for emergency exit use. The facility had adequate shaded outdoor seating for resident use. LPA observed the backyard to contain a fountain that was empty and contained no water. The garage was observed to be locked and inaccessible to clients in care. LPA observed the garage to contain an additional freezer, gardening supplies, cleaning supplies, and care supplies.

KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured cabinet to contain knives and resident medications.

RECORD REVIEW: Record review began at 11:27 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Two (2) staff files were reviewed. Both staff files contained all required documentation and trainings. Four (4) resident files were reviewed. All resident files were observed to contain all required documentation and signatures. No deficiencies were observed during record review.

Continued on LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VIRGINIA CATALINA LLC
FACILITY NUMBER: 197607943
VISIT DATE: 12/02/2025
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MEDICATION REVIEW / CASH RESOURCE REVIEW: Medication review began at 01:20 PM. Medications are stored centrally and securely in a locked cabinet in the kitchen. Medications for three (3) residents were observed. All medications reviewed were documented properly on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. Cash resource review was conducted for two (2) clients. All cash resources were appropriately stored and documented. No deficiencies were observed during cash resource review.

INFECTION CONTROL / EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. The facility’s emergency disaster drills are conducted quarterly and the last emergency disaster drill was conducted on 10/10/2025. The facility’s emergency disaster plan and infection control plan are reviewed/updated by the facility Administrator.

INTERVIEWS: LPA interviewed one (1) staff member, the staff member interviewed was knowledgeable on their role, responsibilities, personal rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. LPA interviewed one (1) resident. The resident interviewed had no concerns with the facility.

During today’s visit LPA obtained a copy of the facility’s updated LIC 500, and liability insurance.

No deficiencies were observed during today's inspection. Exit interview conducted and copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC809 (FAS) - (06/04)
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