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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850144
Report Date: 04/26/2023
Date Signed: 04/26/2023 07:27:27 PM

Document Has Been Signed on 04/26/2023 07:27 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: 4DATE:
04/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Anait DominoTIME COMPLETED:
06:00 PM
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Licensing Program Analyst (LPA) Zabel Chochian arrived to this facility today to conduct a Required Annual inspection. LPA met with staff and Administrator Anait Domio. Reason for the visit was explained. The facility serves level 3 clients from North Los Angeles County Regional Center.  There is sufficient staffing to meet the needs of clients in care. LPA observed four (4) clients in the home resting in their rooms.

At approximately 4:30pm-5pm, LPA toured the facility with Administrator and staff. The kitchen appeared to be clean and the appliances and fixtures functional.  LPA observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects were observed stored in the locked drawer in the kitchen. Medications were observed stored in a locked cabinet also in the kitchen. The home consists of a master bedroom with bathroom which is occupied by two (2) clients and two private rooms occupied by clients. The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each client. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a sufficient supply of personal hygiene for client use. LPA observed two bathrooms to be clean and had functional fixtures. Bathrooms observed stocked with necessary hygiene products (soap, paper towels, toilet paper etc). Laundry area observed in the kitchen. All detergents were observed locked in cabinet. Garage entrance is from the outside. LPA toured the garage and observed sufficient PPE supplies, extra paper towels, toilet paper, supply of water and an extra refrigerator stocked with additional food supply.

At approx 5:30pm the facility smoke detectors and carbon monoxide were tested and functioned properly.
There is no staff room therefore facility provides 24 hour care. Administrator will check with local fire department to see if the facility office space may be used as staff room. If so Administrator will inform Licensing and submit required LIC200 and facility sketch to obtain clearance for a staff room.
Front/backyard - Observed clean and free from any hazards during todays visit.
Due to time constraints, annual visit will continue at a later date. Exit interview held. Copy of report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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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