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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603165
Report Date: 01/27/2024
Date Signed: 01/29/2024 07:55:59 AM


Document Has Been Signed on 01/29/2024 07:55 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:GLEN PARK AT VALLEY VILLAGEFACILITY NUMBER:
197603165
ADMINISTRATOR:TILLMAN PINKFACILITY TYPE:
740
ADDRESS:5527 LAUREL CANYON BLVDTELEPHONE:
(818) 769-6626
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:100CENSUS: 38DATE:
01/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:33 AM
MET WITH:Jessyca MunozTIME COMPLETED:
11:00 AM
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On 01/27/2024, Licensing Program Analyst (LPA) Sandra Urena arrived unannounced to conduct a required annual inspection. The LPA met with staff, and explained the reason for the visit. Administrators are on call on the weekend. The administrator Virginia Sumulong arrived shortly thereafter.

LPA Urena toured the physical plant areas inside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN/DINING ROOM: At 8:43 a.m., the LPA toured the kitchen area along with the facility's chef. The facility has a sufficient supply of non-perishable and perishable food items. Appliances appeared to be in operable condition. The menu was posted. The kitchen and dining room area was observed to be clean and in good condition. The fire extinguisher in the kitchen was served on 12/06/2023. The refrigerator and freezer were observed to be within the required temperatures of 40 degrees and 0 to below 0 degrees. Overall dining room temperature was kept at 71 degrees.

This is part-one of the annual inspection. Due to time constraints, a continuation annual inspection visit will be conducted in the near future.

Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2024
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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