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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600430
Report Date: 06/21/2022
Date Signed: 06/21/2022 04:34:55 PM


Document Has Been Signed on 06/21/2022 04:34 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 CENTERFACILITY NUMBER:
197600430
ADMINISTRATOR:JUDITH MONTOYAFACILITY TYPE:
740
ADDRESS:7720 WOODMAN AVE.TELEPHONE:
(818) 997-6756
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:116CENSUS: 72DATE:
06/21/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Judith Montoya, AdministratorTIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced Case Management-Deficiencies inspection visit at the facility today due to a deficiency observed during the investigation of a complaint visit conducted on 06/21/2022.

Between 1:00 p.m. and 3:20 p.m., the LPA along with the Administrator, conducted a physical plant tour. Between 3:15 p.m. and 3:40 p.m., the LPA observed hot water to be measured between 126.0 and 138.1-degree Fahrenheit. At 3:40 p.m., the Administrator observed the hot water temperature and requested maintenance and plumbing services to set the hot water no more than 120-degree Fahrenheit. At 4:15 p.m., staff adjusted the water temperature and the LPA observed the hot water temperature to be measured at 110.4-degree Fahrenheit.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D).
Civil Penalties issued in the amount of $250.00.

Exit interview conducted with Administrator. A copy of the report, civil penalties and appeals rights were reviewed and emailed to the Administrator.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2022
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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Document Has Been Signed on 06/21/2022 04:34 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/22/2022
Section Cited

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87303(e)(2) Maintenance and Operation Hot water temperature controls shall be maintained to ...of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by:
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Based on observation, the licensee did not comply with the section cited above in as the water temperature in resident bathrooms measured between 126.0 and 138.1 degrees F which poses an immediate health, and safety risk to persons in care.
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Administrator stated that they will maintain hot water temperature between 105 and 120 degrees F and keep a monthly temperature log.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2022
LIC809 (FAS) - (06/04)
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