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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850183
Report Date: 02/09/2023
Date Signed: 02/09/2023 01:46:12 PM


Document Has Been Signed on 02/09/2023 01:46 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:COTTAGES AT THE COLONY OF VALLEY GLEN #2FACILITY NUMBER:
195850183
ADMINISTRATOR:QUINTERO, ELEANORFACILITY TYPE:
740
ADDRESS:5797 HILLVIEW PARK AVETELEPHONE:
(818) 855-7023
CITY:VALLEY GLENSTATE: CAZIP CODE:
91401
CAPACITY:6CENSUS: 6DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:47 PM
MET WITH:Dvora Leventer, AdministratorTIME COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 12:47 p.m., the LPA met with one of the Administrators and explained the reason for the visit. This annual had a specific emphasis on infection control practices and procedures.

At 12:57 p.m., the LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards. BEDROOMS: The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. The sinks had sufficient liquid soap, and paper towels. At 12:58 p.m., hot water measured at 105.8-degree Fahrenheit. Laundry units are located inside one of the restrooms. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances appear to be in an operable condition. The facility has a sufficient supply of perishable and non-perishable food. COMMON AREA: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguishers to be fully charged and last serviced on 11/10/2022. Signs are posted throughout facility to promote handwashing, and cough/sneeze etiquette. At 1:07 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. The LPA observed cameras in the common area. Cleaning solutions, chemicals and hazardous items were inaccessible and locked away inside a closet near the front entrance. Medications and first aid kits are located in a locked closet near the dining area. OUTDOOR SPACE: The LPA observed the back patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for emergency exits. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. The LPA observed 30 days of Personal Protection Equipment (PPE). The facility’s policies and procedures as it pertains to infection control are adequate. No deficiencies were observed at this time. Exit interview conducted. A copy of the report was provided via email and print.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2023
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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