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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609662
Report Date: 12/05/2023
Date Signed: 12/06/2023 05:26:12 PM

Document Has Been Signed on 12/06/2023 05:26 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:TEEN PROJECT INC, THEFACILITY NUMBER:
197609662
ADMINISTRATOR:BURNS, LAURI LYNNEFACILITY TYPE:
772
ADDRESS:8142 SUNLAND BLVDTELEPHONE:
(818) 582-8832
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 16CENSUS: 16DATE:
12/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Anasheh Director Of OperationsTIME COMPLETED:
10:45 AM
NARRATIVE
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On 12/04/2023 at 08:00am Licensing Program Analyst (LPA) Christopher Alemoh and Licensing Program Manager (LPM) Eva Miller conducted a Case Management visit at The Teen Project Inc. At 08:35AM LPA Christopher Alemoh and Eva Miller met with Director of Operations, Anasheh Safarian.

On 12/03/2023 the facility accepted approximately 7 new clients from the next door Substance rehabilitation facility. Teen Project Inc will submit an admissions packet in addition to facility documents of qualifications for current administrator of record by close of business 12/6/23. The existing food service waiver will no longer be in effect as of Friday 12/08/2023. The facility is seeking a new vendor for commercial food delivery and will submit all required documents for a new food service waiver prior to close of business 12/8/23.

During today’s visit LPA Christopher Alemoh and LPM Eva Miller observed the kitchenette did not have enough nonperishable or perishable accessible to residents. LPA and LPM observed there was a black lock on the refrigerator. The kitchenette contained condiments and a bowl of crackers and eleven apples.

Deficiency cited. Appeal rights provided.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 12/06/2023 05:26 PM - It Cannot Be Edited


Created By: Christopher Alemoh On 12/05/2023 at 09:29 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TEEN PROJECT INC, THE
FACILITY NUMBER: 197609662

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2023
Section Cited
CCR
81072(a3)

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To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of
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Director of operations agrees to remove locks from refirgerator and have accessible no perishable food in the kitchenetter for residents in care.
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 shelter, clothing, medication or aids to physical functioning. Thisrequirement was not met, as evidenced by observations of LPA and LPM. There was no food accessible to residents. This posseses a immediate threat to personal rights of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Eva Miller
LICENSING EVALUATOR NAME:Christopher Alemoh
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2023


LIC809 (FAS) - (06/04)
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