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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609360
Report Date: 11/18/2023
Date Signed: 11/18/2023 10:57:04 AM

Document Has Been Signed on 11/18/2023 10:57 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:VALLEYHEART CARE HOMEFACILITY NUMBER:
197609360
ADMINISTRATOR:FENIQUITO, MICHELLEFACILITY TYPE:
735
ADDRESS:22346 PHILIPRIMM STTELEPHONE:
(747) 242-1588
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 4CENSUS: 4DATE:
11/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ricardo Cayanan, Staff TIME COMPLETED:
11:05 AM
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Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:00 a.m., the LPA met with staff and explained the reason for the visit. At 9:06 a.m., the LPA spoke with the Administrators. The Administrator was not available to meet the LPA and authorized staff, Ricardo Cayanan to sign the report. Starting at 9:10 a.m., the LPA, along with staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards.
KITCHEN: The LPA observed the kitchen/dining area. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 9:14 a.m., hot water measured at 105.5-degree Fahrenheit. Medications, first aid kits, cleaning solutions, knives and additional supplies are located in a locked storage cabinet near the kitchen. The LPA observed supplies of emergency food and water in the kitchen area. BEDROOMS: The facility is a single-story residential home with five (5) bedrooms, four (4) for client use and one (1) for staff use. The LPA observed client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: The facility has two (2) restrooms. Client restroom is relatively clean and sanitary and in operating condition with grab bars and non-skid materials. At 9:24 a.m., hot water measured at 105.0-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. OUTDOOR SPACE: At 9:16 a.m., the LPA observed the back patio which has a covered outdoor area for client use. Passageways were free and clear from obstruction. There are no bodies of water on the premises. The property is connected to a city approved ADU. The garage is attached to the house and remains locked and inaccessible to clients. The laundry units are located inside the garage. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 06/19/2023. Signs are posted throughout facility to promote handwashing, and cough/sneeze etiquette. The LPA observed cameras in the common areas.
Between 9:47 a.m. and 9:55 a.m., the LPA conducted interviews with four (4) clients and one (1) staff.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2023
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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