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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609901
Report Date: 02/12/2025
Date Signed: 02/12/2025 04:00:17 PM

Document Has Been Signed on 02/12/2025 04:00 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:CRESCENT HILLSFACILITY NUMBER:
197609901
ADMINISTRATOR/
DIRECTOR:		VALDEZ, ABRAHAM RFACILITY TYPE:
735
ADDRESS:3350 SANTA CARLOTTATELEPHONE:
(818) 749-2745
CITY:LA CRESCENTASTATE: CAZIP CODE:
91214
CAPACITY: 4CENSUS: 4DATE:
02/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Matthew De Vera, Administrator & Ryan Guillermo, Lead Direct Support Professional, DSPTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted a Required One (1) year annual visit and inspection. LPA met with Lead Direct Support Professional (DSP) who called the Administrator and purpose of the visit was stated. Later, Administrator joined the today’s visit. The facility is fire cleared for four (04) ambulatory clients.

At 10:00a.m., DSP and LPA conducted physical plant tour inside and out. During the tour, LPA observed that the facility has (04) bedrooms and three (03) bathrooms. Two (02) private bedrooms, one (01) shared bedroom and one (01) bedroom converted into a staff office. Fire/Earthquake drill was last conducted on 11/13/2024. Required posting observed in facility (complaint hot line poster, personal rights, etc).

The front main door is the only entrance being utilized at the facility. Sign in sheet and hand sanitizer area is located immediately before entrance. The facility had submitted and approved Mitigation and Infection Plan. Hand washing signs were posted in the bathrooms. All trash cans were observed to be with cover.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:
Bedrooms were toured and observed to be clean and properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Linen storage was also checked and observed to have ample supply of clean linen, comforts and towels in the hallway closet. Office designated for staff use maintains staff folder and office supplies.
Bathrooms were observed to be clean, sanitary and with necessary supplies. The appropriate grab bars and mats in the shower. Hot water temperature measured at a range of 112.7°F to 113.5°F and within the required range. Client’s personal hygiene supplied are kept in their personal space. Towels and washcloths are not shared.
(continued to LIC 809-C)
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CRESCENT HILLS
FACILITY NUMBER: 197609901
VISIT DATE: 02/12/2025
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(continued from LIC 809)
Common Areas: These included the living room and dining area for clients. The common areas were properly furnished. Furniture in common area was observed to be in good repair. Fireplaces are closed, blocked-off and non-operational. Clients dining table fits six (06) clients. Laundry area is located adjacent to the staff restroom and garage entrance. Laundry detergent and other toxins are kept in the locked cabinet in the garage. No obstructions and or tripping hazards throughout the facility.
Kitchen Area is observed to be clean and sanitary. All disinfectants, cleaning solutions and other toxins were observed to be locked in the cabinet under the sink. Knives are locked in a combination box on the kitchen counter and inaccessible to clients in care.
Food: LPA observed at least two (02) days perishable and seven (07) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Food storage and preparation areas are clean and inaccessible to pests. Temperature of facility wall thermostat was set at 75.0°Fahrenheit and observed to be within the required range. Fire extinguishers were observed to be located in the kitchen and laundry area. Fire extinguishers were observed to be operable with purchased receipt dated of 01/15/2025. There are battery powered comb smoke/carbon monoxide detectors throughout the facility and observed to be operational.
Medication were observed to be locked, inaccessible and stored in the cabinet in the kitchen. There was a complete first aid kit located inside the hallway closet.
Garage is attached to the house and observed to be locked and inaccessible to clients. The garage storages extra perishable, non-perishable food, cleaning supplies, PPE, client vehicle and other supplies.
Surrounding Grounds The front grounds of the facility are well landscaped. All passageways and stairways were observed to be clear from obstruction. The backyard has outdoor furniture with a covered shaded area for clients. The outdoor area was enclosed, and no bodies of water were observed.
Client records. All four (04) client records were reviewed. Clients record are complete and current at this time. Staff records were also reviewed they all have criminal record clearances and associated to this facility. Staff have current first aid and training documentation showing training completed. Administrator's certificate was observed to be current.

No deficiencies observed during the visit.

Exit interview conducted and a copy of the report issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
LIC809 (FAS) - (06/04)
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