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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850144
Report Date: 04/05/2022
Date Signed: 04/05/2022 03:56:31 PM

Document Has Been Signed on 04/05/2022 03:56 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:VALLEY SWEET HOMESFACILITY NUMBER:
195850144
ADMINISTRATOR:DOMIO, ANAITFACILITY TYPE:
735
ADDRESS:6903 AMESTOY AVENUETELEPHONE:
(747) 265-6154
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 4CENSUS: 3DATE:
04/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Anait Domio - Administrator TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Brian Balisi arrived to this facility today to conduct a One (1) year Required inspection of this facility with emphasis on infection control practices and procedures. LPA met with
Administrator Anait Domio and explained the reason for the visit.

The facility serves clients from North Los Angeles County Regional Center.  Potentially dangerous items are kept inaccessible to clients with developmental disabilities and intellectual disabilities. There is staff to meet the needs of clients with developmental disabilities and intellectual disabilities. 

At approx 1pm, LPA toured the facility with Administrator. The kitchen appeared to be clean at this time and the appliances and fixtures functional during the time of visit.  LPA observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects were observed stored in the top drawer to the right of the oven. LPA observed drawer to be locked at this time. Medications were observed stored in a locked cabinet to the left of the oven. Resident and staff files were observed to be kept in this area as well.

The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a sufficient supply of linen and  personal hygiene  supplies in the hallway closet to the kitchen. At Approx 1:30pm, LPA observed (2) residents attending a zoom class in their room.

LPA observed all bathrooms were clean, properly supplied and had functional fixtures. The hot water was measured in each bathroom  between 105 - 120 degrees Fahrenheit.

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SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2022
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: VALLEY SWEET HOMES
FACILITY NUMBER: 195850144
VISIT DATE: 04/05/2022
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Continued from 809

Common Areas:  These included the living room, dining room, laundry area and office area.   The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Furniture in each room appeared to be relatively clean and functional at this time.  Fire extinguishers were observed to be fully charged and purchased in March 2022. LPA observed  a 30 day supply of PPE stored in entry way closet and in the laundry area. LPA observed laundry area next to the kitchen. Cleaning supplies were observed to be locked in the cabinet across from washing machine at this time.

Outdoor Area:  There was a shaded area with sufficient room for activities. LPA observed sufficient furniture designated for outdoor use. There are no bodies of water on the premises.  LPA observed a sufficient amount of space for activities. LPA did not observe any obstructions to emergency exit at this time. There was an attached garage to the facility. LPA observed garage to store , furniture, extra PPE, emergency equipment, an additional fridge and extra food.

The LPA spoke with Anait regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. 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. If needed, the facility has the capacity to designate the master bedroom as a single isolation room if the facility has a confirmed case of COVID-19. COVID-19 testing is conducted weekly if there are any covid-19 concerns.  The facility’s policies and procedures as it pertains to infection control are adequate at this time.

Exit interview conducted. Report issued and sent via email.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022
LIC809 (FAS) - (06/04)
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