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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610211
Report Date: 01/03/2024
Date Signed: 01/03/2024 02:39:00 PM


Document Has Been Signed on 01/03/2024 02:39 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:KITTRIDGE RCFEFACILITY NUMBER:
197610211
ADMINISTRATOR:MARTIR, FRANCISFACILITY TYPE:
740
ADDRESS:20702 KITTRIDGE STTELEPHONE:
(818) 854-6745
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:6CENSUS: 6DATE:
01/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:James and Susan OlaliaTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Michael Cava conducted a Case Management (CM) visit to the facility to follow up on complaint control #31-AS-20220728112027. During the course of the investigation, it was revealed that Staff 1 (S1) and Staff 2 (S2) did not have their required staff training to satisfy section 87411. LPA met with staff, James and Susan Olalia, and advised them of the visit. This visit is made in conjunction with a required annual.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies were cited (please refer to LIC 809-D for Required One Year dated 01/03/2024).

Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued.

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2024
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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