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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606315
Report Date: 06/12/2024
Date Signed: 06/12/2024 12:53:10 PM

Document Has Been Signed on 06/12/2024 12:53 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:VCT HOME CARE, INC.FACILITY NUMBER:
197606315
ADMINISTRATOR/
DIRECTOR:		VICTORIA TORRESFACILITY TYPE:
740
ADDRESS:16334 LAHEY STREETTELEPHONE:
(818) 360-9833
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 4CENSUS: 4DATE:
06/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Ronald BaritTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
NARRATIVE
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On 06/12/24 at 9:05AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with caregiver Teresita Pugado and disclosed the purpose of the visit. Ronald Barit, the administrator was called and arrived about twenty (20) minutes later.

LPA asked for the census, resident, and staff files.


A physical tour was conducted at 11:15 AM and observed the following:



The Kitchen area was toured, LPA observed there to be sufficient seven (7) day supply of non-perishable foods and seven (7) day perishable food for all residents. The kitchen area was clean at the time of the tour. There is extra, food in the kitchen pantries. The knives are at the bottom of the one (1) of the kitchen cabinets on your right-side locked and inaccessible to the residents. The chemicals are under the sink locked and inaccessible to the residents.

The medications and first aid kit are locked and inaccessible to the residents on top of one (1) of the kitchen cabinets.

The fire extinguisher is located against the wall on your left-hand side of the entrance of the facility. It is fully charged. The expiration date is 01/2025.

The house temperature is at 72-degrees Fahrenheit.

The smoke detectors/carbon monoxides are in the hallway area. They were tested and working properly.



LIC 809C-continued
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: VCT HOME CARE, INC.
FACILITY NUMBER: 197606315
VISIT DATE: 06/12/2024
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Bedrooms: There are four (4) bedrooms and two (2) full bathrooms. Four (4) bedrooms are single, occupied. One (1) of the bedrooms has a private bathroom. The other bathroom is next to one (1) of the closets that are filled with extra food. There is no staff room. All bedrooms and bathrooms were toured and were properly furnished and have appropriate bedding, linens, toiletry, and lightning. The bathrooms have proper toiletry, grab bars and non-skid mats. The bathroom temperatures of the water are within regulations reading at 110–112-degree Fahrenheit.

The living room area has enough seating for the residents and the staff. There is a fireplace that is covered and inaccessible to the residents. The dining area has a television and a telephone line.

Administrative: There is no annual fee that is due right now. The Insurance plan is dated as of 04/2024-04/2025. At the entrance of the facility against the right-side of the facility there is a billboard with signs: Yes and Ombudsman. Against the wall of the kitchen there is the Infection Control Plan, Emergency and Disaster Plan, House Rules, Grievance Procedures, Planned Activities and the Facility Residents Registry.

Outside/Backyard: There is an outside/backyard that is currently inaccessible to the residents in care because of the major construction occurring. There is also a small shed. The facility does not have a signal system. The facility does not have a pool/body of water. The washer and dryer is outside located on your left-hand side of the facility prior to entering the backyard.



Let it be noted, there has been major changes to the original facility sketch. The original facility sketch had five (5) bedrooms. Bedroom #5 is no longer there instead there is a bathroom in that location. The dining hall next to the kitchen is no longer there. There is a partition where the construction is occurring which is inaccessible to the residents. LPA observed an additional room and bathroom under construction in the backyard where the construction is occurring. The garage is no longer there. LPA observed two (2) doors but administrator does not know what will be constructed inside those two (2) doors. There is currently no fire clearance or building permits.

An exit interview was conducted, citation(s) were issued, and a copy of this report was given to the administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 06/12/2024 12:53 PM - It Cannot Be Edited


Created By: Gina Saucedo On 06/12/2024 at 12:17 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: 06/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87208(a)

(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the observation and record review, the licensee did not comply with the section cited above in one out of one area of construction which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2024
Plan of Correction
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The licensee will submit a written declaration explaining the steps that they are going to take to complete the project.
Type A
Section Cited
CCR
87202(a)

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in one out of one area of construction which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2024
Plan of Correction
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Administration/Licensee will need to contact the fire department to receive immediate fire clearance.
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:Troy Agard
LICENSING EVALUATOR NAME:Gina Saucedo
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/12/2024 12:53 PM - It Cannot Be Edited


Created By: Gina Saucedo On 06/12/2024 at 12:24 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: 06/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87305(a)

Prior to construction or alterations, all facilities shall obtain a building permit.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the observation and record review the licensee did not comply with the section cited above in one out of one area of contruction-removal of a bedroom, removal of a garage and new construction which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2024
Plan of Correction
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Administrator/Licensee will need to send the building permit to LPA Saucedo.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Troy Agard
LICENSING EVALUATOR NAME:Gina Saucedo
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024


LIC809 (FAS) - (06/04)
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