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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197602842
Report Date: 04/22/2022
Date Signed: 04/22/2022 11:19:16 AM

Document Has Been Signed on 04/22/2022 11:19 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:LIFE SKILLS TREATMENT PROGRAMFACILITY NUMBER:
197602842
ADMINISTRATOR:BROTMAN, ERICFACILITY TYPE:
775
ADDRESS:215 MACNEIL STREETTELEPHONE:
(818) 898-1926
CITY:SAN FERNANDOSTATE: CAZIP CODE:
91340
CAPACITY: 40CENSUS: 0DATE:
04/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Eric BrotmanTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an infection control visit. LPA met with Administrator Dr. Eric Brothman. The facility is currently still not operating and providing online services to clients. The Administrator informed LPA that, they are planning to start operation approximately in June and structuring how to gradually accept clients back into the day program. The plan is for clients that are not going to attend in person services, connect online with the clients that are at the day program, via on camera and Zoom. Since the facility is not operating, there was no entry COVID procedures in place. Administrator stated, that once the facility begins to operate, visitors, clients, and staff will entered through the front iron gate, which will be locked from the outside, and a motion sensor detects when someone is there, and an alarm within inside the facility will alert staff that someone is at the front gate. At that time, a cleaning station table, with PPE, hand sanitizer, and temperature will be taken and documented using an app. Individuals not associated with the facility, will not be checked. Staff will have to wear full mask covering all day and would be optional for clients. The day program also continues to provide alternate services using Zoom classes. There are average of (30) clients who receive daily alternate program activities. All staff, including interns and volunteers are vaccinated and will receive the booster before operation begins. Administrator reported that he is does not have the accurate number of how many clients are vaccinated; due to family and facilities not wanting to provide the information.

LPA toured the physical plant and conducted a mitigation plan review with the Administrator to ensure the facility has implemented COVID precautionary safety measures. LPA informed the Administrator to begin posting more COVID procedures throughout the facility; especially hand-washing signs in the bathroom. The facility has a fire clearance for (40) clients of which (7) can be non-ambulatory. The day program is located within a church building. The rooms
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2022
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LIFE SKILLS TREATMENT PROGRAM
FACILITY NUMBER: 197602842
VISIT DATE: 04/22/2022
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utilized are the Fellowship room (large activity room), Room (3), which is the library, and rooms (4) and (6) are smaller activity rooms. No medications are stored at the facility. Clients bring their own lunch and the facility provides snacks and drinks. Once the day program begins to operate, they will continue to practice social distancing during activities and meals.

The facility has not hired any new staff; but there are vaccination requirements before employment. There are sick leave policies in place. There are no staffing issues. The Administrator has an agency ‘Right Choice’, that has he used in the past for clients that need 1 to 1 client. Facility has appropriate PPE and cleaning supplies available, and facility will implement an activity for clients to wash their hands twice a day, and clients and staff will clean the facility periodically daily.



Administrator will continue to provide training for staff; especially with COVID procedures and ensured LPA they will continue to implement the best safety practices for staff and clients. Administrator was informed to continue to report any changes to Licensing as needed.

Copy of report provided.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022
LIC809 (FAS) - (06/04)
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