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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606315
Report Date: 02/23/2022
Date Signed: 02/23/2022 02:11:50 PM

Document Has Been Signed on 02/23/2022 02:11 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:VCT HOME CARE, INC.FACILITY NUMBER:
197606315
ADMINISTRATOR:VICTORIA TORRESFACILITY TYPE:
740
ADDRESS:16334 LAHEY STREETTELEPHONE:
(818) 360-9833
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 6DATE:
02/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Ronald Barit - StaffTIME COMPLETED:
02:15 PM
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A Required One (1) year - Infection Control visit was conducted today by Licensing Program Analyst (LPA) Gary Tan. LPA met with staff Ronald Barit. Purpose of visit was stated. LPA observed that all six (6) residents were at the facility during visit. This facility is vendored by North Los Angeles Regional Center.

A tour of the physical plant was conducted at 12:35 AM and the following were noted:

The main door is the only entrance being utilized for entry. There is a sign on the door that everyone entering at the facility must wear mask and must be screened. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened by the staff upon entry. All staff were observed to be wearing mask.

The facility had submitted and approved Mitigation plan.

Signs to wear a mask and other Covid 19 prevention protocol signs were posted on the walls. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. All trash cans were observed to be with cover.

The facility has a designated visitors' area at the front and backyard. The facility has sufficient stock of PPE in the storage room.

The facility has seven (7) bedrooms and three (3) bathrooms currently occupying six (6) residents. One (1) bedroom and one (1) bathroom is designated for staff use. The facility is licensed to care for non-ambulatory clients, two (2) of which may be bedridden.

(continued on LIC 809-C)
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2022
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: VCT HOME CARE, INC.
FACILITY NUMBER: 197606315
VISIT DATE: 02/23/2022
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Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted:

Living and dining room furniture were also checked. The living room is neat and clean. The facility maintains a comfortable temperature at 75°F. The smoke detector and Carbon Monoxide detector are hardwired and interconnected and are tested and observed to be operational. Fire extinguisher was observed to be full and last serviced on 02/21/22.

The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water at the facility. There is a locked shed at the backyard being used as a storage facility. The car port is covered and currently being used as laundry area. Laundry soap, cleaning agents and other toxins are kept in a locked cabinet in the laundry area.

Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are stored at the kitchen drawer and was observed to be secured, locked and inaccessible to residents.

The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene products on each bathroom which is provided by the licensee. Staff Rooms: Staff room was locked. No medication was observed in the staff room.

The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet and shower. The hot water temperature was measured at a range of 115.9°F to 117.8°F. There is sufficient supply of clean linen available in stock at the cabinet.

Medications: LPA observed medication in the medication room to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. Complete first aid kit is readily available.

Exit interview conducted and copy of this report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC809 (FAS) - (06/04)
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