197600306-2-2-2023-29-AS-AASO-CNNLYY-20230202081107

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197600306
Report Date: 02/01/2023
Date Signed: 02/02/2023 08:12:36 AM

Document Has Been Signed on 02/02/2023 08:12 AM - 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:	ACTIVITIES FOR RETARDED CHILDREN AND ADULTS		FACILITY NUMBER:	197600306
ADMINISTRATOR:	CAROLE-ANN SCOTT		FACILITY TYPE:	775
ADDRESS:	6456 WHITSETT AVE.		TELEPHONE:	(818) 762-4365
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY: 36		CENSUS: 30	DATE:	02/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:37 PM
MET WITH:	Corrine Botte		TIME COMPLETED:	03:48 PM

NARRATIVE

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Licensing Program Analyst (LPA) Angel Ascencio conducted an unannounced required annual visit to the above facility. LPA Ascencio met with the Executive Assistant (EA) Corrine Botte and explained the reason for

the visit. This annual had a specific emphasis on infection control practices and procedures. At 1:26 p.m.,

the LPA, along with the EA Botte toured the physical plant areas inside and outside to ensure there are no
health and safety hazards. This Day Program is vended by the North Los Angeles County Regional Center.

RESTROOMS: Public restrooms were observed to be clean and sanitary and in operating condition. The
showers were in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient
amounts of soap and paper products in each restroom, as well as hand washing posters.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good
condition. At the time of the visit, common seating area and dining room furniture was observed to be in good
condition. Chairs were observed to be at least 6 (six) feet apart for social distancing. The LPA observed the
required postings in the common hallway. The facility has several rooms which are utilized for activities with the clients in the day program. The rooms are stocked with a variety of craft materials, music instruments, computers and other activity materials. The second floor has three administrative offices, one computer room and two bathrooms. Fire extinguishers were observed to be serviced within the last year. Carbon dioxide detector was also observed to be working at the time of visit. LPA observed the front yard to have round tables with chairs, and shade for clients to have meals. The backyard has a small shaded area. A basketball court and games area were found to be in good condition. The pool was fenced and locked during the visit.

Continued on LIC 809 - C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

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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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: ACTIVITIES FOR RETARDED CHILDREN AND ADULTS	FACILITY NUMBER: 197600306
	VISIT DATE: 02/01/2023

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KITCHEN: Kitchen appliances were in operable condition. This is a day program facility, and the facility does not provide meals for clients. Clients bring their own lunch, which are stored in two refrigerators located in a room adjacent to the main dwelling. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit.

INFECTION CONTROL: During today’s visit, the LPA spoke with the EA regarding the facility’s
infection control practices at 1:10 p.m. There are 2 entries into the facility. Upon entry, the facility has a point for symptom screening. The LPA noted that the facility is allowing visitors for both indoor and outdoor visitation. The LPA observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The LPA also observed a sufficient supply of medication for client use. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate.

No citations were issued during today’s visit. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

LIC809 (FAS) - (06/04)

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