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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609930
Report Date: 01/06/2025
Date Signed: 01/06/2025 04:11:15 PM

Document Has Been Signed on 01/06/2025 04:11 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:VENTURAFACILITY NUMBER:
197609930
ADMINISTRATOR/
DIRECTOR:
CINDY GARCIAFACILITY TYPE:
735
ADDRESS:729 VENTURA STTELEPHONE:
(626) 529-3776
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 4CENSUS: 4DATE:
01/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Administrator, Cindy Garcia and General Manager, Juana Ivett BusbyTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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At 10:55am Licensing Program Analysts (LPA) Antonia Alvizar-Ettima conducted an unannounced annual inspection at the facility stated above. LPA met with Direct Support Professional (DSP’s), Miranda Rivadeneyra and Andrew Hooper, who granted access to the facility. Then Administrator and General Manager joined the visit.

The facility retains four (04) clients with intellectual disabilities, placed by the San Gabriel/Pomona Regional Center Level 4. The facility is fire cleared for four (04) ambulatory clients.

At approximately, 11:25am LPA, Garcia and Rivadeneyra conducted a physical tour inside and outside.
During the tour, LPA observed that the facility has (4) bedrooms and two (2) bathrooms. Earthquake drill was last conducted on 01/01/2025 and Fire drill on 01/05/2025. Required posting observed in facility (complaint hot line poster, personal rights, etc). There is no body of water in the facility. During the visit the facility is at 71 degrees Fahrenheit.

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 and towels in the hallway.

Bathrooms: Were observed to be clean, sanitary and with necessary supplies. Hot water temperature measured at a range of 115.2°F to 117.8°F and within the required range. LPA observed appropriate grab bar and had non-skid mat. All trash cans in bathrooms had fitted lids to protect from cross contamination. Client’s personal hygiene supplied are kept in their personal space. Cleaning supplies are being stored in a locked cabinet in hallway. Towels and washcloths are not shared.
Cont. LIC 809-C
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2025
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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: VENTURA
FACILITY NUMBER: 197609930
VISIT DATE: 01/06/2025
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Kitchen: Was observed to be clean and sanitary. All disinfectants, cleaning solutions and other toxins were observed to be locked in the cabinet in the hallway. 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. Canned non expired food was stored in kitchen and extra in the pantry hallway. All knives and sharps are observed to be locked in a locked staff office in locked drawer and inaccessible to clients. The facility has a working gas stove, microwave, refrigerator and freezer.
Medications: Were observed to be locked and centrally stored in the cabinet, inside locked staff office by the den and inaccessible to clients in care. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. The laundry appliances are located in the kitchen and den areas. The dryer is the kitchen and washer in den. LPA observed all detergents and other toxins locked and inaccessible to clients in care. There is a fire extinguisher in the family room, den and staff office they were last purchased on 12/16/2024.
Common Areas: These included the living room, family room and dining area for clients. The common areas were properly furnished. Furniture in common areas was observed to be in good repair. Fireplace was empty and non-operational. Staff office is located in the den. Dual smoke and carbon detectors were located throughout the facility and observed to be operational. No obstructions and or tripping hazards throughout the facility. Clients dining table fits four (04) clients and activity table fits five (05).
Outside Areas: Were observed with appropriate outdoor furniture, a covered shaded area for clients. Exit area are free of obstructions and hazards. LPA checked inside of the locked and inaccessible to clients shed detached to the house. Shed was used for facility maintenance purposes, extra cleaning supplies and holiday decorations. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. There is no garage only parking port.
Client Records: All four (04) client records were reviewed. Clients records are complete and current at this time.
Staff records: Three (03) staff records were reviewed, they all have criminal record clearances and associated to this facility. Staff have current First Aid and training documentation showing training completed. Administrator certificate was observed to be current.

No deficiencies observed during this visit. Exit interview conducted. Copy of the report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC809 (FAS) - (06/04)
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