191222639-9-25-2024-29-AS-SURA-D9FSQ4-20240925140409

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191222639
Report Date: 09/25/2024
Date Signed: 09/25/2024 02:04:56 PM

Document Has Been Signed on 09/25/2024 02:04 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:	ONEGENERATION - MARK TAPER J.O.Y. PROGRAM		FACILITY NUMBER:	191222639
ADMINISTRATOR/ DIRECTOR:	ANNA SWIFT		FACILITY TYPE:	775
ADDRESS:	17400 VICTORY BLVD.		TELEPHONE:	(818) 708-6625
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91406
CAPACITY: 90		CENSUS: 27	DATE:	09/25/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:45 AM
MET WITH:	Anastasia Plyugina		TIME VISIT/ INSPECTION COMPLETED:	02:13 PM

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Licensing Program Analysts (LPA) Sandra Urena conducted an unannounced required annual visit. Upon arrival LPA met with Anastasia Plyugina- Adult Day Director and explained the reason for the visit. The Adult Day program is a part of the Inter-generational program. The program includes an adult day program, and childcare participants.

The LPA, and the Director 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.

COMMON AREA: The common area consists of the lobby/reception area/observation areas. The LPA observed required postings throughout the common space. The fire extinguishers were fully charged and were last serviced 06/12/2024. The facility maintained a comfortable temperature of 71 degrees. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. Emergency/Evacuation Drill was last conducted on 06/12/2024.

ACTIVITY ROOMS: Two (2) Activity rooms, one large for exercises, meals, etc., and a smaller activity room for additional activities. Rooms were observed to clean, and furniture was observed to be in good condition.

NURSE STATION: Nurses’ station was observed to store medication, first aid, PPE, and all were observed to be inaccessible to clients.

LAUNDRY ROOM: It is located across the hall from women's restroom. Cleaning supplies and detergent were observed to be stored in this area and was inaccessible to clients during the visit.

Continues on LIC 809C…

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ONEGENERATION - MARK TAPER J.O.Y. PROGRAM	FACILITY NUMBER: 191222639
	VISIT DATE: 09/25/2024

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REHAB ROOM: The LPA observed room to be clean, and the furniture was observed to be in good condition.

OUTDOOR/PATIO: The patio has a shaded area and is equipped with furniture for clients' use. No bodies of water were noted. Outside area was observed free of clutter and obstruction. Parking is located in the front of the building. LPA did not observe any obstructions or hazards during the visit.

KITCHEN/DINING: The kitchen/dining area appeared clean and sanitary; appliances and fixtures were observed to be functioning during the time of the visit. Perishable and non-perishable foods were observed to be properly stored. LPA observed sufficient room in the fridge for clients to store snacks and beverages. All knives and cleaning supplies were observed to be inaccessible at time of visit.

RECORDS: Records review began at 12:30 p.m. Residents’ records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the facility appropriate training.

MEDICATIONS: Medications review began at approximately 1:45 p.m. The medications are centrally stored in a medication cart that was observed inaccessible to clients at this time. Medications are properly documented on the centrally stored medications and destruction record.

INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient at this time.

Exit Interview Conducted. A copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

LIC809 (FAS) - (06/04)

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