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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850330
Report Date: 03/29/2023
Date Signed: 03/29/2023 04:24:18 PM

Document Has Been Signed on 03/29/2023 04:24 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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:VENUS RESIDENTIALFACILITY NUMBER:
565850330
ADMINISTRATOR:URAMOTO, TODD KAZUYUKIFACILITY TYPE:
735
ADDRESS:1871 BURCH AVETELEPHONE:
(818) 518-8701
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 4CENSUS: 4DATE:
03/29/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Todd Kazuyuki UramotoTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Zabel Chochian conducted an announced Pre-licensing visit to the facility and met with Administrator/Licensee applicant Todd Kazuyuki Uramoto and Assistant Administrator Hamada Abdelhalim. This is a change of ownership application from Venus Residential (#565801373) to Venus Residential (#565850330). Applicant successfully completed Component II on 03/20/2023 and Component III during todays visit.

LPA inspected facility for fire safety, personal accommodations, and food service. The facility smoke alarm and combined carbon monoxide system is hard wired and was functional during the inspection. There is one fire extinguisher in the kitchen.

The home capacity is for 4 ambulatory individuals. Fire clearance was granted on 02/23/2023.

The facility is a single-story home consisting of a living room, dining room, kitchen, activity area, 5 total bedrooms (4 for client use), 1 bathroom. There is a covered backyard patio and garden area which wraps around and exits on the side of the house.

LPA inspected the clients' rooms, observing them to be clean and appropriately furnished. Bathrooms were sanitary and functional. Hot water temperature measured between 105 and 120 degrees Fahrenheit. The kitchen was clean and adequately supplied with perishable and non-perishable foods. Knives are located in a locked drawer and cleaning supplies in a locked cabinet. Common areas appropriately furnished. Back patio is shaded for client use.

Following corrections needed prior to license: Existing Licensee needs to provide appropriate written notifications to clients, responsible persons and Community Care Licensing. Lighting in clients rooms should be sufficient. Exit interview conducted copy of report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023
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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