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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610489
Report Date: 05/29/2024
Date Signed: 05/29/2024 01:52:36 PM

Document Has Been Signed on 05/29/2024 01:52 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:VELVET CARE 2FACILITY NUMBER:
197610489
ADMINISTRATOR/
DIRECTOR:		PAROYAN, NAIRAFACILITY TYPE:
740
ADDRESS:16909 CITRONIA STREETTELEPHONE:
(310) 480-2009
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 6CENSUS: 5DATE:
05/29/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:38 AM
MET WITH:Cynthia Sherriel -StaffTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On 05.29.2024 in conjunction with an initial complaint visit control number 31-AS-20240521091912. Licensing Program Analyst (LPA) Leslie Ngo-Castaneda completed an unannounced CASE MANAGEMENT- Deficiencies visit. LPA met with designated licensee Cynthia Sherriel, explained the purpose of the visit.

From 10:15AM to 11:30AM, interviewed (4) out of four (4) staff and four (4) out of five (5) residents. During the interview and observation it was revealed the facility made a passageway from the garage to the facility hallway without any prior approval from fire department any advice to the regional office. Facility sketch did not include the new construction to the garage to the hallway. The new construction does not have a permit to use this area as a passageway. Therefore, the allegation is deemed substantiated.

According to the California Code of Regulations, Title 22, Division 6, the following deficiency is cited:
See LIC 9099-D for citation.

Appeal Rights Discussed/An Exit Interview was conducted.
A copy of this report was left at the facility.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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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Document Has Been Signed on 05/29/2024 01:52 PM - It Cannot Be Edited


Created By: Leslie Ngo-Castaneda On 05/29/2024 at 12:28 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: VELVET CARE 2
FACILITY NUMBER: 197610489

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/29/2024
Section Cited
CCR
87305(a)

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Section 87305(a) Alterations to Existing Building or New Facilities. Prior to construction or alterations, all facilities shall obtain a building permit. LPA observed that a portion of the garage has a new passageway from the garage to the hallway of the facility.
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Liciensee shall remove, close and lock the passageway from the garage and the hallway and agrees to comply with Title 22 regulations regarding accommodations. Plan of correction is due by 6.12.2024
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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:Nichelle Gillyard
LICENSING EVALUATOR NAME:Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:
DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2024


LIC809 (FAS) - (06/04)
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