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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606315
Report Date: 06/17/2022
Date Signed: 06/17/2022 12:04:42 PM

Document Has Been Signed on 06/17/2022 12:04 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:
06/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Teresita Pugugado/ CaregiverTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in order to conduct an Inspection Control Annual. LPA was greeted by facility staff and his temperature was taken and COVID-19 questions were asked before being allowed entry.

LPA was able to briefly tour the inside and outside of the facility. There are 6 bedrooms designated for residents use. The smoke alarms and carbon monoxide detectors were tested and all functioned properly. The fire extinguisher was last serviced on 2/21/2022 and appeared functional. The facility is currently following their approved mitigation plan.

Exit interview conducted and report issued.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2022
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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