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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609360
Report Date: 11/14/2024
Date Signed: 11/14/2024 09:31:06 AM

Document Has Been Signed on 11/14/2024 09:31 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/
DIRECTOR:		FENIQUITO, MICHELLEFACILITY TYPE:
735
ADDRESS:22346 PHILIPRIMM STTELEPHONE:
(747) 242-1588
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 4TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
11/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:40 AM
MET WITH:Kevin ScanlanTIME VISIT/
INSPECTION COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 07:40AM. LPA met with Administrator Kevin Scanlan and explained the reason for the visit.

Beginning at 07:43AM, the LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards. The following was observed:

KITCHEN/GARAGE: LPA toured the kitchen at 07:43AM. Kitchen appliances were clean and in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Medications, first aid kits, cleaning solutions, knives and additional supplies are located in a locked storage cabinet near the kitchen. LPA observed supplies of emergency food and water in the kitchen area. There is a locked garage by the kitchen containing a washer and dryer, cleaning solutions and chemicals, detergents, and an additional refrigerator and freezer.

BEDROOMS: The facility is a single-story residential home with five (5) bedrooms of which four (4) are for client use and one (1) is for staff use. LPA observed client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. The staff bedroom was kept locked.

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 09:09AM, hot water measured at 107.9 degrees Fahrenheit. The sinks had sufficient liquid soap, and paper towels.

Report continued on LIC 809-C.
Kristin HeffernanTELEPHONE: (818) 596-4493
Angela BarutyanTELEPHONE: 747-922-1234
DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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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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: VALLEYHEART CARE HOME
FACILITY NUMBER: 197609360
VISIT DATE: 11/14/2024
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OUTDOOR SPACE: At 07:55AM, 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 areas to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 06/04/2024. Required postings are posted throughout facility to promote handwashing, and cough/sneeze etiquette. LPA observed cameras in the common areas that have a muted audio component.

RECORD REVIEW: Beginning at 08:04AM, LPA reviewed four (4) out of four (4) client and three (3) personnel files for documents including but not limited to: medical records, care plans, Admission Agreement, TB test, health screening, staff training and fingerprint clearance. All client and personnel files were in order.

MEDICATION REVIEW: At 09:13AM, LPA reviewed medications for all four (4) clients. Medications are centrally stored and locked in a cabinet by the kitchen area. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors were observed during the medication review.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency drills are conducted quarterly as is required, with the last drill conducted on 10/11/2024.



No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angela BarutyanTELEPHONE: 747-922-1234
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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