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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802416
Report Date: 12/01/2023
Date Signed: 12/18/2023 04:30:44 PM


Document Has Been Signed on 12/18/2023 04:30 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:VILLA TERESA RESIDENTIAL CAREFACILITY NUMBER:
565802416
ADMINISTRATOR:MARILOU ROJASFACILITY TYPE:
740
ADDRESS:821 TERESA STREETTELEPHONE:
(805) 604-7772
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY:6CENSUS: 5DATE:
12/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Marilou RojasTIME COMPLETED:
12:23 PM
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Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual visit at 9:39 a.m. The LPA initially met with two caregivers. The administrator Marilou Rojas and licensee/administrator George Yazbek arrived approximately 20 minutes later. LPA explained the reason for the visit.

The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The carbon monoxide and smoke alarms were tested and all functioned properly. The fire extinguisher appeared fully charged and was last inspected on 1/23/2023. KITCHEN: Caregivers were preparing breakfast so some locks on cabinets were open. LPA observed knives are stored in a locked drawer and chemicals are stored in a locked cabinet under the sink. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of perishable and non-perishable food. BEDROOMS: The LPA observed two double-occupancy bedrooms and two single-occupancy bedrooms, appropriately furnished. RESTROOMS: Restrooms are clean and sanitary and in operating condition. Hot water temperature was 114*F. COMMON SPACES: The living room, family room and dining room furniture was observed to be in good condition. The LPA observed the required postings throughout the facility. The backyard patio is equipped with furniture for residents' use. The garage and staff room were locked. Medication is stored in a locked cabinet in the hall/desk area. Medications were reviewed and appear to be given as prescribed. The administrator and two staff records, including training records, were reviewed and appear to be complete. Two resident files were reviewed and appeared complete.INFECTION CONTROL: LPA observed an adequate supply of Personal Protection Equipment (PPE) and licensee can obtain additional supplies as needed. The facility has appropriate plans in place in the event clients and/or staff show symptoms of or test positive for COVID. Cleaning protocols were sufficient.

No deficiencies were observed at the time of the visit. Exit interview conducted. Report provided to administrator.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2023
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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