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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603303
Report Date: 03/24/2022
Date Signed: 03/24/2022 12:36:10 PM

Document Has Been Signed on 03/24/2022 12:36 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:VALLEY VILLAGE ADULT DAY CARE - SUNLANDFACILITY NUMBER:
197603303
ADMINISTRATOR:DONNA THOMASFACILITY TYPE:
775
ADDRESS:8727 FENWICK STREETTELEPHONE:
(818) 446-0366
CITY:SUNLANDSTATE: CAZIP CODE:
91040
CAPACITY: 80CENSUS: 7DATE:
03/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Gary JamesTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced infection control visit. LPA met with Program Director Gary James and explained the purpose of today's visit. The facility is comprised of two programs an Adult Day Program and Adult Day Health Care. Upon entering the facility, LPA was greeted by Program Director of the Adult Day Health Care Program Jose Fernandez, who checked LPA’s temperature and requested LPA to sign in the visitors’ book. LPA observed staff to have full mask covering; a hand sanitizing station; PPE supplies at the reception area. LPA was informed the facility has been COVID free since there last positive case in January 2022. At this time, the facility is gradually accepting clients back. The current census was (7).; but they continue to provide alternate services, such as delivery of activities, and Zoom classes. There are (30) clients who receive daily alternate program activities. 99% of staff and clients are vaccinated and have booster shots.

LPA toured the physical plant and conducted a mitigation plan review with Program Director Gary, to ensure the facility has implemented COVID precautionary safety measures. The property consists of one large building, which includes the Administration & Nurses station, reception area, (6) bathrooms, sensory, physical therapy room, kitchen, computer & communication room, arts and craft, and large activity room. LPA was informed, the facility uses (2) entry doors for staff and (1) door, located in the back of the facility for clients only. Upon everyone’s entry, staff and client’s temperature are checked and documented by Program Directors. The facility cohort clients by household; all activities and meals are provided together, to mitigate commingling amongst other clients in different households. LPA observed the clients in different rooms, eating and participating in activities with staff. The facility provides hot meals, snacks, and drinks, that is catered and provided from a local vendor.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2022
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: VALLEY VILLAGE ADULT DAY CARE - SUNLAND
FACILITY NUMBER: 197603303
VISIT DATE: 03/24/2022
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Hand washing signs are posted in bathrooms, along with soap and towels. Rite Aide conducts COVID testing at the facility when needed. The facility has procedures in place to monitor staff and clients for potential outbreaks. Program Director informed LPA that the facility has not hired any new staff; but there are no vaccination requirements as of yet, for new hires. There are sick leave policies in place. There are no staffing issues or concerns. LPA was informed if there are staffing issues, they will temporarily cease operation and continue with remote services. Facility has appropriate PPE and cleaning supplies available and cleans daily. A cleaning company also provides services after hours.

Program Directors 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. Program Director was informed to continue to report any changes to Licensing as needed. LPA also requested new Administrator information to be emailed to make the necessary changes.


Exit interview and copy of report provided.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
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