197600430-10-19-2022-29-AS-EPEI-CKCTH4-20221019144407

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197600430
Report Date: 10/19/2022
Date Signed: 10/19/2022 02:45:05 PM

Document Has Been Signed on 10/19/2022 02:45 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 VIEW RETIREMENT CENTER		FACILITY NUMBER:	197600430
ADMINISTRATOR:	JUDITH MONTOYA		FACILITY TYPE:	740
ADDRESS:	7720 WOODMAN AVE.		TELEPHONE:	(818) 997-6756
CITY:	PANORAMA CITY	STATE: CA	ZIP CODE:	91402
CAPACITY:	116	CENSUS: 71	DATE:	10/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:42 AM
MET WITH:	Judith Montoya, Administrator		TIME COMPLETED:	02:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 10:42 a.m., the LPA met with the Administrator and explained the reason for the visit. This annual had a specific emphasis on infection control practices and procedures. At 11:10 a.m., the LPA and the Administrator began the physical plant tour inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with the Title 22 Regulations. BEDROOMS: The LPA observed multiple resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Passageways were free and clear from obstruction. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skids mats. Between 11:09 a.m. and 11:26 a.m., the LPA observed hot water to be measured between 105.8 and 108.1-degree Fahrenheit. COMMON AREAS: At 11:16 a.m., the LPA observed staff cleaning common areas and hallways on both the first and second floor. At 11:22 a.m., the LPA observed common areas to be relatively clean and properly furnished. The LPA observed fire extinguishers throughout the facility hallways on both floors and all were last serviced on 10/10/2022. Fire alarm system was observed and was last tested on 07/27/2021 with an expiration date of 05/31/2024. The LPA observed cameras installed in the hallways and common areas. Continued on LIC 809-C.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

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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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 VIEW RETIREMENT CENTER	FACILITY NUMBER: 197600430
	VISIT DATE: 10/19/2022

NARRATIVE

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KITCHEN: At 11:45 a.m. LPA observed the kitchen/dining area. Knives are stored in the locked kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food.

OUTDOOR SPACE: LPA observed the side and front lot, which has a covered outdoor area for resident use. There is an open gate at the front of the facility.

Medications and first aid kits are in a locked medication room located on the ground floor. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the maintenance room.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator 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. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s policies and procedures as it pertains to infection control are adequate.

No deficiencies. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

LIC809 (FAS) - (06/04)

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