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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191201168
Report Date: 05/20/2022
Date Signed: 05/20/2022 04:15:13 PM


Document Has Been Signed on 05/20/2022 04:15 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:VILLA SCALABRINI RETIREMENT CENTERFACILITY NUMBER:
191201168
ADMINISTRATOR:ADILSO LUIZ BALENFACILITY TYPE:
740
ADDRESS:10631 VINEDALE STREETTELEPHONE:
(818) 768-6500
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY:130CENSUS: 86DATE:
05/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Alicia AvilaTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Wendell Smith conducted an Required Annual visit to this facility in conjunction with a complaint visit.. LPA met with assistant administrator Alica Avila and explained the reason for this visit.

LPA conducted a physical plant walk through of the facility from 2:15-2:55pm . Facility has a memory care unit within the assisted living unit of the facility. Memory care unit has eight residents residing in it. LPA inspected random resident bedrooms and bathrooms. LPA also toured the kitchen, dining, activity room, library, and medication room. LPA observed bedrooms and bathrooms to be appropriately furnished. LPA observed common areas along with the activity and dining room to be appropriately furnished. LPA observed residents to be partaking in activities during the visit. LPA checked the kitchen for the ability to prepare and store food. LPA observed there to be a sufficient amount of perishable and non perishable food. During the walk through LPA did not observe any immediate health and safety issues. LPA observed that the facility is following current infection control guidelines and protocols, including but not limited to: screening visitors, wearing PPE, posting signs reminding staff/residents/visitors about handwashing and how to recognize Covid symptoms, updating emergency contact information, training staff and ensuring resident personal rights.
No deficiencies cited. Exit Interview conducted.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell SmithTELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
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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