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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609360
Report Date: 01/26/2024
Date Signed: 01/26/2024 05:31:23 PM

Document Has Been Signed on 01/26/2024 05:31 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: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:
01/26/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Michelle Feniquito, Administrator, Ricardo Cayanan, Staff TIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced Case Management - Annual Continuation at the facility today continuing the inspection that began on 11/18/2023. At 2:08 p.m., the LPA met with the Administrators.

At 2:10 p.m., the LPA conducted a brief physical plant tour to ensure there are no health and safety hazards.

RECORD REVIEW: Between 2:20 p.m. and 4:36 p.m., the LPA conducted a file review for all clients and staff regularly scheduled and observed the following: Staff have current first aid and training documentation showing required training completed. Client records were reviewed for, but not limited to current IPP, care plans, medical records, admissions agreement, and consent forms. All files were in order.

At 4:45 p.m., the LPA conducted a review of medication and medication documentation with the Administrator for two (2) clients and observed that all medications were properly documented and assisted as prescribed.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2024
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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