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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603675
Report Date: 03/07/2022
Date Signed: 03/07/2022 03:28:53 PM

Document Has Been Signed on 03/07/2022 03:28 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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:GILMAR MANORFACILITY NUMBER:
197603675
ADMINISTRATOR:VLADIMIR CHERTOKFACILITY TYPE:
735
ADDRESS:15152 VICTORY BLVD.TELEPHONE:
(818) 989-2651
CITY:VAN NUYSSTATE: CAZIP CODE:
91411
CAPACITY: 78CENSUS: 67DATE:
03/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Gabriela Chavez - Assistant AdministratorTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual. This annual had a specific emphasis on infection control practices and procedures. Upon arrival LPA met with Assistant Administrator Gabriela Chavez and explained the reason for the visit.

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

Kitchen: The kitchen appeared clean and the appliances and fixtures functional at this time. LPA found a sufficient amount of perishable food stored in the fridge and non-perishable food properly stored. Additional non-perishable foods and emergency food supply were observed to be properly stored in a storage closet on the second floor. Kitchen was inaccessible to clients at this time.



Bedrooms: LPA inspected randomly selected bedrooms. All bedrooms for clients use were properly furnished and had appropriate bedding and linens.

Bathrooms: All bathrooms inspected appeared to be clean, properly supplied and had functional fixtures.

Common Areas: These included dining areas, activity room and patio. The common areas were properly furnished and relatively clean. At approx 02:15pm, LPA observed multiple clients watching television in the dining area. There was a communal staff fridge and (2) vending machines located in this area. LPA observed signs to wipe down each appliance after each use and sanitizer readily available.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2022
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: GILMAR MANOR
FACILITY NUMBER: 197603675
VISIT DATE: 03/07/2022
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Continued from 809

Surrounding Grounds: The Parking garage is attached to the facility. Emergency/disaster and PPE supplies are properly stored in several areas easily accessible to staff. LPA observed (3) laundry rooms (2) on the second floor and (1) on the first floor. Laundry room on the 2nd was designated for clients use. LPA observed laundry room and staff laundry room to be clean and fixtures appeared to be functional at this time. LPA observed patio furniture appropriate for outdoor use and plenty of room for outdoor activities. LPA did not observe any obstructions to emergency exits at this time.


INFECTION CONTROL: During today’s visit, LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility does not have a confirmed case of COVID-19 at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate.

Exit interview conducted. Report issued and sent via email.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022
LIC809 (FAS) - (06/04)
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