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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603303
Report Date: 12/05/2023
Date Signed: 12/05/2023 03:01:24 PM

Document Has Been Signed on 12/05/2023 03:01 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.RO, 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: 69DATE:
12/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Program Director Jose HernandezTIME COMPLETED:
03:10 PM
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On 12/5/2023 at approximately 11:30AM Licensing Program Analyst (LPA) Christopher Alemoh conducted an unannounced annual inspection. LPA met with Program Director Jose Hernandez 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’s temperature was checked and was asked to sign in on the visitor’s log. LPA observed facility to have full mask covering; a hand sanitizing station; PPE's supplies at the reception area. Census on 12/05/2023 was (69) Program Director Hernandez stated 99% of staff and clients are vaccinated and have booster shots. The complex is comprised of two programs an Adult Day Program and Adult Day Health Care.

LPA Alemoh initiated toured a physical plant at 12:30PM. LPA was escorted through the facility by Program Director Jose Hernandez, to ensure the facility has implemented COVID precautionary safety measures. The property consists of one large building, which includes the Administration & Nurses station, and the reception area. Facility has (6) gender neutral bathrooms, LPA measured water temp at 118 degrees Fahrenheit. The facility also has a sensory, physical therapy room, computer & communication room, arts and craft, and large activity room all rooms were being used by clients during LPA’s visit. The kitchen is fully stocked and operational. Knives and sharp objects are locked and secured.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: VALLEY VILLAGE ADULT DAY CARE - SUNLAND
FACILITY NUMBER: 197603303
VISIT DATE: 12/05/2023
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(Continued from LIC 809)

All gatherings and meals are served in the cafeteria. LPA was informed, the facility uses (2) main entrances/exits Client entrance is on the east side of building next to the parking lot. Another entrance is for staff only and this is located on the northwestern side of the building. LPA observed the clients and staff in different rooms, engaging and participating in activities. The facility provides hot meals, snacks, and drinks, that are catered for and provided by a local vendor. All smoke alarms and carbon monoxide detectors are hardwired and were tested during the visit. Facility has a sprinkler system this also hardwired. LPA observed First aid kit and manual in emergency preparedness kit at reception desk. Valley Village conducted an Emergency Fire Drill on 12/5/2023.



No deficiencies cited.

Exit interview conducted and a copy of the Appeal Rights were given.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC809 (FAS) - (06/04)
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