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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197602842
Report Date: 11/28/2023
Date Signed: 11/28/2023 03:48:16 PM

Document Has Been Signed on 11/28/2023 03:48 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
WOODLAND HILLS S.ASC, 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: 21DATE:
11/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Antonia Alvizar conducted an unannounced Annual Required visit to this Adult Day Program. LPA met with Manager, Alice Flores and explained the reason for the visit. At approximately 10:30a.m. Administrator, Eric Brotman joined us.

At 10:45a.m. LPA and Manager tour the physical plant for compliance with safety, maintenance, and operational requirements. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

The facility has fire clearance for 40 clients of which 7 can be non-ambulatory. The day program is located within a church building. The facility serves clients with developmental disabilities and intellectual disabilities (DD/ID).

There is one entrance being utilized at the facility, there are required posters thought the facility. Smoke detectors were tested and function properly. Facility disaster drills was conducted on 04/11/2023. There are charged fire extinguisher in the facility. Fire extinguisher are located in the kitchen and room #4. Fire extinguisher are fully charged and serviced on 07/19/2023.



Potentially dangerous items are kept inaccessible to clients such cleaning supplies and toxic chemicals are kept locked in room #4. Hot water temperature was tested in common bathrooms and kitchen. The hot water temperatures measured between 111.2 - 118.1 degrees Fahrenheit (F) which are within the required range for clients comfort and safety.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2023
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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LIFE SKILLS TREATMENT PROGRAM
FACILITY NUMBER: 197602842
VISIT DATE: 11/28/2023
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Continued from 809)

Kitchen: There is no requirement in the Day Program to maintain a one week supply of nonperishable, and two day supply of perishable food, although emergency water is maintained on the premises. LPA observed plenty of snacks in the facility.

Bathrooms: LPA observed all bathrooms to be clean, properly supplied and had functional fixtures. LPA observed grab bars, stalls and a urinal in bathrooms.

Common Areas: The the fellowship room (large activity room), Rooms #4 and #6 as smaller activity rooms. The common areas were checked for cleanliness and furniture was checked for functionality. All areas were clean, sanitary and in good repair. At 1:46 p.m. LPA observed clients playing Bingo in the fellowship room.

Surrounding Grounds (Outdoors): There was a shaded area with proper furniture for outdoor use with in the courtyard located the middle of the buildings. There are no bodies of water and firearms on the premises.

In addition to the physical plant LPA conducted a file review for residents and staff regularly scheduled. Staff have current first aid and training documentation showing required training completed. Resident records observed to be complete at this time. LPA interview clients and staff during today’s visit. There is enough staff to meet the needs of the clients.

Per California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, deficiencies were not observed/cited. Exit interview conducted and copy of report provided to Administrator.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC809 (FAS) - (06/04)
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