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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610099
Report Date: 03/17/2025
Date Signed: 03/17/2025 02:33:43 PM

Document Has Been Signed on 03/17/2025 02:33 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:WYNGATE VILLA GARDENSFACILITY NUMBER:
197610099
ADMINISTRATOR/
DIRECTOR:		CHAVEZ, OSCARFACILITY TYPE:
740
ADDRESS:7634 WYNGATE STREETTELEPHONE:
(818) 352-4270
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY: 68CENSUS: 49DATE:
03/17/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Oscar ChavezTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
NARRATIVE
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On 03/17/25 LPA Casillas arrived at facility above to conduct an initial 10-day complaint investigation for complaint # 31-AS-20250312131151. This Case Management is not related to the original complaint visit.

During the facility tour LPA observed that cleaning supply cart was left unattended for an extended period of time. This allowed residents to have access to cleaning supplies. LPA asked staff why it was left unattended and staff replied that the cleaning staff was performing another duty. LPA asked staff to please call cleaning staff to return to cart and put away the supplies until they are able to supervise them appropriately. LPA waited for cleaning staff member to return and take charge of cart.

LPA explained to Administrator the importance of ensuring that harmful products are not left unattended if outside the locked storage area. LPA explained to Administrator that a citation would be issued for this deficiency. LPA also advised Administrator that there needs to be a training of all staff on the importance of keeping harmful items locked for resident safety. Administrator will email LPA a copy of the training that was provided along with a log of all staff that was in attendance by end of POC date.

Report signed by designee Ricardo Rodriguez as Administrator had to leave before LPA was able to deliver report.

Citation Issued. Appeal rights discussed and provided. Exit Interview conducted.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2025
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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Document Has Been Signed on 03/17/2025 02:33 PM - It Cannot Be Edited


Created By: Lorena Casillas On 03/17/2025 at 10:35 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: WYNGATE VILLA GARDENS
FACILITY NUMBER: 197610099

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/24/2025
Section Cited
CCR
87309(a)

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87309(a)Storage Space and Access ...the licensee shall ensure that disinfectants, cleaning solutions…and other similar items ....are in locked storage and are not left unattended if outside the locked storage. This was not met as evidenced by:
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Supply cart with cleaning supplies was put away in LPA’s presence. Administrator will email LPA a copy of the training that was provided along with a log of all staff that was in attendance by end of POC date.
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Based observation, staff do not ensure that cleaning supplies were inaccessible to residents in care, this poses a potential health and safety and personal rights risk to persons 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:Nichelle Gillyard
LICENSING EVALUATOR NAME:Lorena Casillas
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2025


LIC809 (FAS) - (06/04)
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