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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850144
Report Date: 04/17/2024
Date Signed: 04/17/2024 03:42:39 PM

Document Has Been Signed on 04/17/2024 03:42 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:VALLEY SWEET HOMESFACILITY NUMBER:
195850144
ADMINISTRATOR/
DIRECTOR:		DOMIO, ANAITFACILITY TYPE:
735
ADDRESS:6903 AMESTOY AVENUETELEPHONE:
(747) 265-6154
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 4CENSUS: 4DATE:
04/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:34 PM
MET WITH:Anait DomioTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Valeria Conway arrived at the 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.

Potentially dangerous items are kept inaccessible to clients with developmental disabilities and intellectual disabilities. There is sufficient staffing to meet the needs of clients in care. LPA observed one (1) clients in the home resting in their rooms. LPA was informed that there are two (2) clients out in the community and one (1) client at a Drs. Appointment.

At approximately 12:10 p.m., LPA toured the facility with Administrator at around 12:25 p.m. back up Administrator arrived at the facility. The kitchen appeared to be clean and the appliances and fixtures functional. LPA observed a sufficient amount of perishable and non-perishable food throughout the facility and 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. Also, all cleaning supplies were locked under the kitchen sink. At 12:45 p.m. the hot water was measured and it was between 105 - 120 degrees Fahrenheit.

The home consists of a master bedroom with bathroom which is occupied by two (2) clients and two (2) private rooms occupied by individual 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. First aid kits were observed throughout the facility complete an respective manual inside.

Continued on LIC 809-C
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: VALLEY SWEET HOMES
FACILITY NUMBER: 195850144
VISIT DATE: 04/17/2024
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Continued from 809

LPA observed two bathrooms to be clean and had functional fixtures. LPA observed a sufficient supply of personal hygiene for client use. Bathrooms observed stocked with necessary hygiene products (soap, paper towels, toilet paper, etc.) At 12:37 p.m. the hot water was measured in each bathroom between 105 - 120 degrees Fahrenheit.

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 October 2023. At approximately 12:50 p.m. the facility smoke detectors and carbon monoxide were tested and functioned properly.

Laundry area observed next to the kitchen. All detergents, extra toileting and cleaning supplies, and three (3) clients cash resources were observed locked in a few cabinets inside the laundry room.

Resident and staff files were observed to be kept in the office. At 1:27 p.m. 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. Last earthquake drill was conducted on 03/08/2024.

Centrally stored medication and records reviewed at approximately 3:15pm. No discrepancies observed.
There is no staff room therefore facility provides 24 hours care.

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 is a self-latched gate on the side of the property use as an emergency exit. 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.
No citations observed during today’s visit/ Exit interview conducted/ A copy of report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
LIC809 (FAS) - (06/04)
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