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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850144
Report Date: 07/07/2023
Date Signed: 07/07/2023 06:25:44 PM

Document Has Been Signed on 07/07/2023 06:25 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:
07/07/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Anait DominoTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Zabel Chochian arrived to this facility today to continue with the Required Annual inspection initiated on 04/26/2023. LPA met with Administrator Anait Domio and staff. Reason for the visit was explained. LPA was informed that there are three (3) clients in the home in their rooms and one (1) client is out in the community.

At approximately 2:30pm, LPA toured the facility with Administrator. 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. All cleaning supplies, disinfects and detergents were locked in cabinet. Client rooms observed with required furniture, clean and in order. Clients expressed being happy with the care and service provide by staff.

At approximately 3pm, Staff and client files were reviewed: Required training and staff records observed on file for current employees. Required client records observed on file and up to date.

Centrally stored medication and records reviewed at approximately 3:45pm. No discrepancies observed.

At approximately 4:15pm, Smoke and carbon monoxide detectors tested and functioned properly

Facility observed to be in compliance. No deficiencies cited.

Exit interview conducted. Copy of report provided to Administrator.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2023
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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