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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802442
Report Date: 11/25/2024
Date Signed: 11/25/2024 01:07:01 PM

Document Has Been Signed on 11/25/2024 01:07 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:R&J RESIDENTIAL CARE HOMEFACILITY NUMBER:
565802442
ADMINISTRATOR/
DIRECTOR:		CARINO, CHRISTIAN RYANFACILITY TYPE:
740
ADDRESS:2160 HANCOCK PLTELEPHONE:
(805) 253-0483
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 4TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
11/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:34 AM
MET WITH:Michelle Viernes, Administrator, Ryan Carino, Licensee TIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:34 a.m., the LPA met with staff and explained the reason for it visit. At 10:01 a.m., the Licensee Christian Ryan Carino and Administrator, Michelle Viernes arrived at the facility. The home is vendored by Tri-Counties Regional Center as a level 4-I home.

Starting at 10:02 a.m., the LPA, along with the Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards.

KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked cabinet near the kitchen. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:03 a.m., hot water measured at 113.0-degree Fahrenheit. Medications and first aid kit are located in a locked cabinet near the kitchen.

BEDROOMS: There are four (4) resident bedrooms and one (1) staff room. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level.

RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 10:12 a.m., hot water measured between 106.1 and 113.0-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels.

OUTDOOR SPACE: At 10:05 a.m., the LPA observed the back patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. There are no bodies of water on the premises. Continued on LIC-809.
Kristin HeffernanTELEPHONE: (818) 596-4493
Emily PeraldiTELEPHONE: 818-421-4497
DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/25/2024
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: R&J RESIDENTIAL CARE HOME
FACILITY NUMBER: 565802442
VISIT DATE: 11/25/2024
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COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 12/05/2023. At 10:13 a.m., fire alarms/carbon monoxide detectors were tested and functioned properly. The garage is where the washer and dryer are held, including additional nonperishable and perishable food items, and locked cleaning supplies.

RECORD REVIEWS: Between 10:16 a.m. and 11:14 a.m., the LPA conducted a file review for all residents and staff regularly scheduled and observed the following: Staff have current first aid and training documentation showing required training completed. Resident records were reviewed for, but not limited to current Individual Programming Plan (IPP), medical records, P & I funds, admissions agreement, and consent forms. All files were in order. The Administrator’s Certificate for Michelle Viernes expires 03/19/2026. The last disaster drill took place 11/15/2024.

Starting at 12:10 p.m., the LPA conducted a review of medication and medication documentation with the Licensee for four (4) out of four (4) residents and observed medications were properly documented and assisted with as prescribed.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC809 (FAS) - (06/04)
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