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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610165
Report Date: 12/19/2022
Date Signed: 12/19/2022 02:54:16 PM


Document Has Been Signed on 12/19/2022 02:54 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:MCNULTY VILLAFACILITY NUMBER:
197610165
ADMINISTRATOR:WOOD, CHERIEFACILITY TYPE:
740
ADDRESS:20724 MCNULTY PL.TELEPHONE:
(818) 395-6037
CITY:CANOGA PARKSTATE: CAZIP CODE:
91306
CAPACITY:6CENSUS: 6DATE:
12/19/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Cherie Wood, Administrator TIME COMPLETED:
03:00 PM
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An Informal Conference was conducted today in the Woodland Hills Adult and Senior Care Regional Office. The purpose of this Informal Conference is to discuss recent deficiencies, and a complaint, with allegations of
Present at today's meeting are the following:
  • Jin Struve, Licensee
  • Cherie Wood, Administrator
  • Eva Miller, Licensing Program Manager
  • Michael Cava, Licensing Program Analyst
  • Angela Panushkina, Licensing Program Analyst

The informal conference process was explained to the Licensee. On 11/8/2022, the Regional Office received a complaint alleging Unlawful Eviction. The complaint was investigated by LPA Cava, and substantiated. Findings were delivered with citations on 11/10/22. The licensee has since submitted their Plan of Correction (POC). During today's Informal, Licensing Program Manager (LPM), Miller requested for an additional POC, which is an addendum to the facility's Admission Agreement, indicating that the facility will not give an eviction notice to any resident, in order to admit an ALW client instead. And the only time the facility can admit an ALW client, is if they have an opening. The Licensee was also informed that continued non-compliance will result in a Non-Compliance Conference. Moving forward, the Administrator was advised that they are a mandated reported, and it is their responsibility to submit an SOC 341, to the ombudsman, the licensing agency and law enforcement.



In conclusion, it was agreed that once the addendum to the Admission Agreement is complete, the Regional Office will receive a copy.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2022
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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