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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800253
Report Date: 03/04/2025
Date Signed: 03/04/2025 10:56:25 AM

Document Has Been Signed on 03/04/2025 10:56 AM - 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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ASSOCIATION FOR RETARDED CITIZENS - VENTURAFACILITY NUMBER:
565800253
ADMINISTRATOR/
DIRECTOR:		MITCHEL GARCIAFACILITY TYPE:
775
ADDRESS:3340 E. LOS ANGELES AVENUETELEPHONE:
(805) 527-1358
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 90CENSUS: 26DATE:
03/04/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Mitchel GarciaTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced Case Management - Incident visit to follow up on a SOC 341 received by the department on 02/21/2025. Upon arrival, the LPA met with Program Manager, Mitchel Garcia and explained the reason for the visit. Entrance interview conducted.

It was reported that on 02/20/2025, there was a staff shortage at the day program which left the participants to be left unattended for certain periods of time. Additionally, the staff shortage resulted in the staff to participant ratios to be off as there was not enough staff to follow the necessary staff to participant ratios.

During today’s visit, between 9:30 a.m. and 10:45 a.m., the LPA conducted interviews with two staff, conducted a participant file review, and obtained copies of pertinent documents relevant to the investigation.

No immediate health or safety concerns noted during today’s visit.

The LPA will return at a later date to complete the investigation if warranted.

Exit interview conducted and copy of report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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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