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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600430
Report Date: 07/12/2021
Date Signed: 07/12/2021 03:27:43 PM

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 VIEW RETIREMENT CENTERFACILITY NUMBER:
197600430
ADMINISTRATOR:JUDITH MONTOYAFACILITY TYPE:
740
ADDRESS:7720 WOODMAN AVE.TELEPHONE:
(818) 997-6756
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:116CENSUS: 74DATE:
07/12/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Judith MontoyaTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Martha Guzman Chavez conducted an unannounced case management visit to the above facility. LPA met with Administrator Judith Montoya and explained the reason for today’s visit.

On 12/24/2020, the Department issued PIN 20-48-ASC, which notified licensees of a requirement to submit a Mitigation Plan Report by 01/24/2021. The PIN advised licensees that ‘Due to the global COVID-19 pandemic, the California Department of Social Services is requiring all licensees of Adult & Senior Care facilities to submit a Mitigation Plan Report to address epidemic outbreaks or communicable diseases specific to COVID-19 by January 24, 2021 pursuant to the following sections of the California Code of Regulations (CCR): Title 22, (Section 87211(a)(2).

Administrator had Mitigation Plan ready and handed a hard copy to LPA during visit.

LPA returned to facility at 2:20pm to have report signed. Report singed by Representative of facility, Mark Ingber.


Pursuant to Title 22, Division 6, facility observed to be compliant with regulation. No corrections needed at this time. Exit interview conducted. A copy of the report and appeal rights were provided via email.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Guzman-ChavezTELEPHONE: (818) 596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021
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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