195850080-2-23-2022-29-AS-EPEI-CBWS9K-20220223124052

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850080
Report Date: 02/23/2022
Date Signed: 02/23/2022 12:41:20 PM

Document Has Been Signed on 02/23/2022 12:41 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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	VENTURA CANYON CARE		FACILITY NUMBER:	195850080
ADMINISTRATOR:	SUKIASYAN, ARMAN		FACILITY TYPE:	740
ADDRESS:	7938 VENTURA CANYON AVE		TELEPHONE:	(818) 205-6365
CITY:	PANORAMA CITY	STATE: CA	ZIP CODE:	91402
CAPACITY:	6	CENSUS: 0	DATE:	02/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Arman Sukiasyan, Administrator		TIME COMPLETED:	12:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit at 11:30 a.m. LPA met with Administrator, Arman Sukiasyan. This annual had a specific emphasis on infection control practices and procedures. At the time of the visit, the facility census is zero (0). At 11:37 a.m. LPA and Administrator began the physical plant tour inside and outside to ensure there are no health and safety hazards and facility is in compliance with the Title 22 Regulations. COMMON AREAS: At 11:41 a.m., LPA observed common areas to be relatively clean and properly furnished. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. KITCHEN: At 11:40 a.m., LPA observed the kitchen/dining area. Knives will be stored in a locked kitchen drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 12:15 p.m., kitchen hot water temperature measured at 105.2-degree Fahrenheit. Currently, there are no residents, but medications and first aid kit will be located in a locked file cabinet near the kitchen. BEDROOMS: At 11:41 a.m., LPA observed resident bedrooms. Two of the bedrooms are model rooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Passageways were free and clear from obstruction. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars. Restrooms had appropriate supplies of paper products and hand soap. At 12:15 p.m. LPA observed hot water to be measured at 114.2-degree Fahrenheit. Continued on LIC 809-C.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VENTURA CANYON CARE	FACILITY NUMBER: 195850080
	VISIT DATE: 02/23/2022

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Continued from LIC 809.

OUTDOOR SPACE: At 11:46 a.m., LPA observed the backyard, which has a covered outdoor area for future resident use. Laundry units are located near the covered patio.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility will have a central entry point for symptom screening, temperature checks, and a sanitation station. Although the facility has no residents, the facility has a mitigation plan in place and their policies and procedures as it pertains to infection control are adequate.

Between 11:55 a.m. – 12:05 p.m., LPA conducted Infection Control mitigation module with Administrator.

Administrator will notify LPA when the first resident is admitted.

No deficiencies cited. Exit interview conducted. A copy of the report will be emailed.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

LIC809 (FAS) - (06/04)

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