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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606315
Report Date: 01/23/2023
Date Signed: 01/23/2023 04:06:52 PM

Document Has Been Signed on 01/23/2023 04:06 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:
01/23/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Victoria TorresTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced Case Management Visit in conjunction with an initial complaint visit (Complaint Control Number: 20230118161528). LPA met with the administrator, Victoria Torres, and explained the reason for the visit.

During a physical plant tour, LPA discovered conflicting facility layouts that do not conform with the Department’s approved facility sketch. The first conflict was discovered in the room labeled “Staff Room” which was approved as one room with a window and closet, however, facility built an unapproved floor-to-ceiling wall which runs down the middle of the room and the only window (wall runs the length of the room and each side of the room shares a portion of one window). The room also has an unapproved interior door to gain access to the right side of the Staff Room (essentially, a room within a room). The other conflict was discovered in the room labeled “Room #5” (five). This room also has an unapproved wall that runs the length of the room, but unlike the Staff Room, it has individual entry doors and a full window in each room. The facility labeled the doors #5 and #6. Furthermore, in Room #4 (four), LPA discovered electrical wires running from the outlet through the bedroom wall into the closet, then runs along the floor, from one side of the closet door to the other, then through the interior of the closet wall, and out through the bedroom wall to power a wall mounted television. These wires pose a potential tripping hazard. LPA also discovered that the carbon monoxide detector in the dining/kitchen area is not operational. Smoke detectors in the hallways are old and also not operational.

Under Title 22 regulations, the following citations are issued and recorded on LIC 809-D.

Exit interview conducted and a copy of the report was issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2023
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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Document Has Been Signed on 01/23/2023 04:06 PM - It Cannot Be Edited


Created By: Abeye Duguma On 01/23/2023 at 03:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: VCT HOME CARE, INC.
FACILITY NUMBER: 197606315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/30/2023
Section Cited
CCR
87305(a)

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Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement was not met, evidenced by:Based on LPA observations the facility has been altered
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Administrator is to send picture proof of the removed walls to the LPA by the POC due date.
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and the facility did not provide the building permits or new facility sketch to LPA for Staff Room and Room #5 division/partitions. This is an immediate health and safety risk to residents in care.
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Type B
01/30/2023
Section Cited
CCR87303(a)

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Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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Administrator is to send picture proof of the removed wires to the LPA by the POC due date.
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This requirement is not met as evidenced by: Based on LPA's observations, bedroom #4 has electrical wires on the closet floor which poses a potential tripping hazard to residents and poses a potential health, safety or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Naira Margaryan
LICENSING EVALUATOR NAME:Abeye Duguma
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023


LIC809 (FAS) - (06/04)
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