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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608650
Report Date: 05/21/2025
Date Signed: 05/21/2025 01:28:04 PM

Document Has Been Signed on 05/21/2025 01:28 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:VISTAS - NORTH HOLLYWOODFACILITY NUMBER:
197608650
ADMINISTRATOR/
DIRECTOR:		YANETT PEREZFACILITY TYPE:
775
ADDRESS:10940 VICTORY BLVD., SUITE 103TELEPHONE:
(818) 509-0150
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 45CENSUS: 13DATE:
05/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Yanett Perez - Program DirectorTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced for a required one-year annual inspection today. Upon arrival, the LPA met with Program Director, Yanett Perez and Chief Operating Officer, Yaniv Geller and explained the reason for the visit. Entrance Interview.

Starting at 10:05am, the LPA along with the Program Director toured the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

The day program operates Monday through Friday from 9:00am to 1:00pm. There are thirteen (13) participants, and seven (7) program staff present today. The day program is currently staffed appropriately with the necessary staff to participant ratios. The facility has three (3) activity rooms, an office, and a kitchen/cafeteria area.

KITCHEN / CAFETERIA: At 10:10am, the LPA observed the kitchen/cafeteria area. Kitchen area was clean, and appliances appeared to be in operable condition. The refrigerator was observed with participant lunches and snacks.

COMMON AREAS: Activity rooms were observed to be furnished appropriately, and all furniture was observed to be in good condition at the time of the visit. The facility maintained a comfortable temperature.

Report Continued on LIC 809C...

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Martha Arroyo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2025
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VISTAS - NORTH HOLLYWOOD
FACILITY NUMBER: 197608650
VISIT DATE: 05/21/2025
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Report Continued from LIC 809...

The LPA observed required postings throughout the common space. Activities are both designed for both as individuals and as a group. The LPA observed staff interacting with participants during time of visit. Equipment used for activities was in good condition at the time of the visit. Cleaning supplies were observed in a locked closet inaccessible to participants at the time of the visit. Exit signs were posted in the hallways. No obstructions or hazards were observed inside or out. Emergency food and water was observed; properly stored. No bodies of water noted at the time of the inspection.

BATHROOMS: There are two (2) restrooms for participant use. Restrooms were clean and sanitary. The bathrooms were sufficiently stocked with soap and paper towels. Starting at 10:18am, the hot water temperature was measured and they measured within the required range of 105 and 120 degrees Fahrenheit.

FILE REVIEW: Records review began at approximately 10:43am.

Eight (8) participant records were reviewed for the following: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, and needs & service plan / Individual Program Plans (IPP). All participant records were in order.

Seven (7) staff files were reviewed for, but not limited to, the following: personnel records, health screening, criminal record statements, valid first aid/CPR, and yearly training. Training records are up to date and on file. All staff records were in order.

INFECTION CONTROL / EMERGENCY DISASTER TRAINING: 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 it pertains to infection control are adequate.

Report Continued on LIC 809C...

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Martha Arroyo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VISTAS - NORTH HOLLYWOOD
FACILITY NUMBER: 197608650
VISIT DATE: 05/21/2025
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Report Continued from LIC 809C...

The LPA observed two (2) fire extinguishers; they were fully charged and were last serviced 08/13/2024. The last fire inspection was completed on 07/22/2024 and was found to be in compliance with Fire Code Regulations at the time of the re-inspection. Fire and earthquake drills conducted quarterly as per regulation; the last one being a fire drill which was conducted on 05/05/2025.

MEDICATIONS: There are currently no participants taking medications during day program. However, if necessary, medications will be stored and locked inside the office.

No citations issued. Exit interview conducted. A copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Martha Arroyo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC809 (FAS) - (06/04)
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