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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600225
Report Date: 06/11/2024
Date Signed: 06/11/2024 01:39:19 PM

Document Has Been Signed on 06/11/2024 01:39 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 S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:L.A.R.C. INDUSTRIESFACILITY NUMBER:
197600225
ADMINISTRATOR/
DIRECTOR:		GLORIA ALLISONFACILITY TYPE:
775
ADDRESS:26639 VALLEY CTR. DR., #105TELEPHONE:
(661) 254-1946
CITY:SANTA CLARITASTATE: CAZIP CODE:
91351
CAPACITY: 65CENSUS: 39DATE:
06/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Corrinne Dombovary - SupervisorTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness met with day program supervisor Corrinne Dombovary, for the facility's annual inspection. LPA explained the reason for the visit; and Administrator Chris Bratzel was contacted via cellphone and also informed of the visit.

LPA conducted a physical plant of the inside and outside of the facility. The following was observed:
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, thermometer, hand sanitizer, gloves and masks are available when needed. All staff and clients were observed to be wearing masks upon entrance and during the visit; they are currently mandated by the day program, due to a recent COVID case. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and throughout the facility. There are approximate (7) staff on duty and client's attendance averages (40) daily. Clients are transported by program, client's home, or ARF. Transportation is provided by Regional Center. There are cubbies and lockers for client's to store personal belongings. The activity area, consists of table and chairs with various activities programs and assignments. There is also computers for client's use. Some clients go out into the community and participate in activities. They are provided a $25.00 monthly stipend to spend at there leisure. The facility has a couch to be used for a resting area. Medication is locked and stored in the supervisor's office. It is transported daily to the day program, by the client's home. Client's bring lunch; but food is provided and available if needed. Snacks, coffee, tea, juice, and water is provided by the program. There is a washer and dryer to wash linens and client's clothing if needed. The facility has a total of three (03) restrooms for staff and clients use. Kitchen area was 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 with fire sprinklers.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: L.A.R.C. INDUSTRIES
FACILITY NUMBER: 197600225
VISIT DATE: 06/11/2024
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The facility is scheduled on 06/21/2024, for maintenance and operational use. Fire extinguishers are located throughout the building, observed charged. The bathroom was checked for cleanliness and proper operations; hot water temperature was measured at 111.2°F. There is a complete first aid kit located in the supervisor's office.

Staff and client files were reviewed; all required documents and training records were observed. Medication records were reviewed; no errors observed.

Exit interview and copy of report provided.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
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