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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850226
Report Date: 02/09/2023
Date Signed: 02/09/2023 04:02:30 PM

Document Has Been Signed on 02/09/2023 04:02 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 CONNECTIONS-BALTARFACILITY NUMBER:
195850226
ADMINISTRATOR:MORTEL, PAULINEFACILITY TYPE:
735
ADDRESS:17138 BALTAR STTELEPHONE:
(818) 223-7299
CITY:LAKE BALBOASTATE: CAZIP CODE:
91406
CAPACITY: 4CENSUS: 4DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:59 PM
MET WITH:Pablo Mortel - Assistant Administrator TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual. This annual had a specific emphasis on infection control practices and procedures. Upon arrival LPA met with Assistant Administrator Pablo Mortel and explained the reason for the visit.

LPA spoke with Administrator Pauline Mortel over the phone who stated they could not be present at the facility, but Pablo will sign in their place.  This home is licensed to serve (4) ambulatory clients with intellectual disabilities at Level II which North Los Angeles County Regional Center is the vendor.

At approximately 1pm LPA  conducted physical plant along with Pablo.  LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. Smoke detectors and Carbon Monoxide detectors appeared to function properly during time of visit.

Facility is a single-story residence and consists of a total of three (3) bedrooms and two (2) bathrooms designated for clients use. (1) bedroom is designated for staff use at this time. LPA observed it to be empty at this time.   Fire clearance was approved for  (4) ambulatory residents. Fire extinguishers were observed to be fully charged and purchased July 18 2022.  During physical plant tour LPA observed the required postings throughout the facility. 

Kitchen:  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 are stored in a locked cabinet above the washer and dryer in the laundry area right next to the kitchen.  No Cleaning supplies and toxins were observed in this area at this time. To the right of the kitchen was the  office area and dining room. Dining furniture in kitchen and dining room area  appeared to be clean and sufficient at this time.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
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)
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VALLEY CONNECTIONS-BALTAR
FACILITY NUMBER: 195850226
VISIT DATE: 02/09/2023
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Continued from 809
Bedrooms:  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 right outside of Clients' room #2.

Bathrooms:  LPA observed all bathrooms were clean, properly supplied and had functional fixtures. The hot water was measured in each bathroom between 109 - 110 degrees Fahrenheit.

Common Areas:  These included the living room,  dining area and office area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Dining room furniture appeared to be relatively clean and functional at this time. Medications were observed stored in locked cabinets in the office area. Client files were observed locked in cabinets in this area as well. LPA observed (3) first aid kits properly supplied including a first aid manual.

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. Garage was accessible from the exterior.  LPA  observed a sufficient amount of PPE at this time. The garage mainly stored linen, some furniture pieces, and medical supplies. LPA observed a storage unit located in the far right corner of the property, inaccessible to clients in care. LPA observed storage unit to store extra clothing , and personal items of one of the clients. The facility is gated with accessibility through driveway entrance. LPA observed gate to be only opened manually at this time.

INFECTION CONTROL: During today’s visit, LPA spoke with Pablo regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. LPA observed 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 would relocate resident to a hotel to isolate. The facility has not had a confirmed case of COVID-19 at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate at this time.

Exit interview conducted and report issued to back up Administrator.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
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
LIC809 (FAS) - (06/04)
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