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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610605
Report Date: 08/20/2024
Date Signed: 08/20/2024 03:27:49 PM

Document Has Been Signed on 08/20/2024 03:27 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:TORRES HOMES HARVEST STREET FACILITYFACILITY NUMBER:
197610605
ADMINISTRATOR/
DIRECTOR:		CABRERA, HENRYFACILITY TYPE:
735
ADDRESS:15018 HARVEST STTELEPHONE:
(818) 287-1375
CITY:MISSION HILLSSTATE: CAZIP CODE:
91345
CAPACITY: 4CENSUS: 0DATE:
08/20/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:33 PM
MET WITH:Gershom Benitez - Licensee RepresentativeTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Gary Tan conducted an announced Pre licensing visit on this date. LPA met with Licensee representative Gershom Benitez. A Fire Clearance dated 04/29/24 is approved for four (4) ambulatory clients. This will be a North Los Angeles Regional Center vendored facility Level II.

LPA toured the facility inside and out at 12:50 PM. Dual smoke and carbon monoxide alarms are hard wired and interconnected. The facility has four (4) client bedrooms. Each room is furnished with beds, lights, night stands and seating. One additional (1) bedroom is designated for staff use. Sufficient closet space was observed for each room. Medication will be stored in a cabinet in the kitchen. Medication storage is equipped with a lock to ensure medications will not be inaccessible to clients. Storage for client and staff records are also observed to be locked in the cabinet in the bedroom hallway. There is a working telephone on the premises.

Common areas were appropriately furnished and lighting was adequate. LPA observed a fully charged fire extinguisher in the dining room bought in 07/29/24. A complete first aid kit was observed in the kitchen. The water temperature in client restrooms was measured at a range of 106.7°F to 118.9°F. Appliances in the kitchen were clean and all appeared functional.

The garage will be used as a Laundry area, new washer and dryer are properly installed. Laundry detergent and other cleaning supplies are stored in a locked cabinet in the garage. The garage is also being used as Emergency food and PPE storage.

(continued to LIC 809-C)
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: TORRES HOMES HARVEST STREET FACILITY
FACILITY NUMBER: 197610605
VISIT DATE: 08/20/2024
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(continued from LIC 809)

The backyard of the facility was also inspected to ensure compliance. The backyard activity area is free of obstruction. Outdoor furniture is also observed in the patio. There is no body of water in the facility. The exterior passageways and exits were clean and clear of any obstructions. No other health and safety hazard present.

Component III is waived as the Administrator has more than three (3) years of experience as a back up Administrator in another same level facility with the approval of LPM Troy Agard.

The facility appears to be compliant with regulations. A copy of this report will be submitted to the application specialist for final review.

An exit interview was conducted and a copy of this report Issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
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