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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600225
Report Date: 01/26/2022
Date Signed: 01/26/2022 12:38:04 PM

Document Has Been Signed on 01/26/2022 12:38 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:L.A.R.C. INDUSTRIESFACILITY NUMBER:
197600225
ADMINISTRATOR:GLORIA ALLISONFACILITY TYPE:
775
ADDRESS:26639 VALLEY CTR. DR., #105TELEPHONE:
(661) 254-1946
CITY:SANTA CLARITASTATE: CAZIP CODE:
91351
CAPACITY: 65CENSUS: DATE:
01/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Chris Bratzel, Executive OfficerTIME COMPLETED:
12:27 PM
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Licensing Program Analyst (LPA) Abeye Duguma met with Executive Officer Chris Bratzel for a One (1) Year Required - Infection Control visit for this facility. LPA explained the reason for the visit. A tour of the physical plant was conducted at 10:00am and the following was noted:
There is one entrance being utilized at the facility, there are required posters posted at the main door. Screening area is located immediately upon entrance. Sign-in sheet, infrared thermometer, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing masks upon entrance and during the visit. Signs to wear masks and other COVID 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and throughout the facility. The facility has sufficient stock of PPE in the staff room located on the southwest side of the facility near the common/activities room. The facility has sufficient stock of hygiene products stored on the southwest corner of the building adjacent to the staff room. The facility has a total of three (03) restrooms for program participants and staff. The facility does not have a swimming pool/body of water. Kitchenette area is clean and inaccessible to pests. The facility keeps knives and sharps in a locked storage cabinet and lock box in the staff room. Common/activities room furniture were checked and appear to be in good condition. The common/activities room is neat and clean. The facility maintains a comfortable temperature at 70°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. The facility has a fire sprinkler system. Fire extinguishers are located throughout the building, observed to be full and last inspected on 01/18/2022. Hallways/passageways are well lit. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 116.2°F. There is a complete first aid kit located in the supervisor's office located on the southwest side of the building near the common/activities room.
Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2022
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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