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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850301
Report Date: 01/21/2025
Date Signed: 01/21/2025 12:47:56 PM

Document Has Been Signed on 01/21/2025 12:47 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:VILLARIANA CAREFACILITY NUMBER:
565850301
ADMINISTRATOR/
DIRECTOR:		BUSCH, HELEN ROSE T.FACILITY TYPE:
740
ADDRESS:4731 READING DRIVETELEPHONE:
(319) 360-1230
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 6CENSUS: 5DATE:
01/21/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Helen Rose T. Busch -Co- Administrator TIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced Required - 1 Year Continuation inspection and arrived at the facility at 10:30 a.m. This is a continuation from the 12/23/2024 Required - 1 Year inspection. Upon arrival, LPA was greeted by staff and Co-Administrator. Today, the LPA met with Co - Administrator Helen Rose T. Busch and explained the reason for the inspection. Co- Administrator Johnna Udden arrived during the inspection. At 10:34 a.m- 10:50 a.m the LPA briefly toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations.

RECORDS: Records review began at 10:53 a.m., Four (4) Personnel records including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. At 11:10 a.m. five (5) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. All files were in order at this time.

EMERGENCY DISASTER PLAN: LPA reviewed the facility's emergency disaster plan, which was recently updated. Emergency drills are conducted quarterly, with the last completed drill documented on 11/15/2024 and the next one scheduled for February.

INFECTION CONTROL PLAN: During today's visit, LPA reviewed the facility's infection control plan. The facility's policies and procedures related to infection control are adequate.

(Report Continued on LIC 809C...)

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE: DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VILLARIANA CARE
FACILITY NUMBER: 565850301
VISIT DATE: 01/21/2025
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(Report Continued from LIC 809C...)

INTERVIEWS: Two (2) staff interviews and two (2) resident interviews were conducted during the inspection. Staff interviews revealed that staff are knowledgeable in resident rights, different forms of abuse and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit.

During today’s visit, the LPA obtained copies of the following: LIC 500 Personnel Report, LIC 9020 Resident Roster, and current liability insurance.

No deficiencies were cited during today’s inspection. Exit interview conducted. A copy of the report reviewed and provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025
LIC809 (FAS) - (06/04)
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