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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609930
Report Date: 02/16/2023
Date Signed: 02/16/2023 11:17:05 AM

Document Has Been Signed on 02/16/2023 11:17 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:VENTURAFACILITY NUMBER:
197609930
ADMINISTRATOR:CINDY GARCIAFACILITY TYPE:
735
ADDRESS:729 VENTURA STTELEPHONE:
(626) 529-3776
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 4CENSUS: 4DATE:
02/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Hilda Villegas & Jason SmithTIME COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an annual inspection. LPA met with Facility Manager Hilda Villegas, who allowed LPA to enter the facility. LPA temperature was checked and COVID screening was conducted. LPA was informed, that the facility has (2) positive clients who were isolating in there rooms. LPA observed COVID signs posted at the front door, and inside the facility. Once it was acknowledged that there were COVID clients, LPA did a brief walk through and continued the visit outside the facility in the back yard. Licensee Jason Smith arrived, and LPA continued to the inspection.

LPA observed the living and dining, and kitchen area. The remaining of inspection was conducted with the Licensee. There are currently (4) clients. There are (4) private rooms, and (2) bathrooms. There were (2) staff on duty with proper COVID masks. Staff clean the facility several times a day, and temperature checks are conducted and documented every shift. Due to the positive cases, they will check temperatures more frequently during the day. COVID screening questions are in place.

All (4) clients and (8) staff are vaccinated and have received the booster. Any new staff that are hired, the requirement is to have proof of vaccination. They continue to follow Public Health guidelines, and there is a sick leave policy in place. Facility continues to weekly COVID test staff and clients. Licensee reported the facility receives departmental emails and forwards them to managers, who conduct weekly training with staff. Currently, the facility has sufficient staff, and has back-up staff in place if needed. LPA was informed the mitigation and infection control plan was submitted and approved.

PPE supplies are delivered weekly and Regional Center, also provides extra supplies when needed.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: VENTURA
FACILITY NUMBER: 197609930
VISIT DATE: 02/16/2023
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At this time due to the positive cases, all clients are isolated, and meals are delivered to there rooms. Activities are in there rooms, and COVID testing will take place tomorrow, and depending on the results, COVID screening will be lifted.

Licensee will continue to provide training for staff; especially with COVID procedures and ensured they will continue to implement the best safety practices for staff and clients. LPA requested to continue to report any changes to Licensing as needed. There were no other issues or concerns noted during this inspection.

Exit interview and copy of report provided.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC809 (FAS) - (06/04)
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