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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606385
Report Date: 10/19/2022
Date Signed: 10/19/2022 01:20:40 PM

Document Has Been Signed on 10/19/2022 01:20 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 NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ARC VENTURA COUNTY(ARCADE)FACILITY NUMBER:
197606385
ADMINISTRATOR:MARY KAY SAWYERFACILITY TYPE:
775
ADDRESS:295 S. ARCADE DRIVETELEPHONE:
(805) 652-0541
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 100CENSUS: 49DATE:
10/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:08 PM
MET WITH:Mary Kay Sawyer, AdministratorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Cortez conducted an on-site 1 year infection control annual visit to the facility above on 10/19/2022 at 12:08 PM. LPA met with Administrator and explained the purpose of the visit.

LPA took a physical plant tour of the inside and outside of the facility with Administrator.
The facility has an entry point where everyone entering completes sign-in and temperature check for all staff, clients, and visitors wanting to come into the facility. All documentation is kept in on file.

The facility has procedures and plans for screening, isolation, testing, when to call 911 and notifying all responsible parties and agencies when needed. Administrator and Safety Rep are in charge of infection control and provides training and education to staff, clients and visitors.

If any suspected or confirmed cases of Covid-19 are found inside or outside the facility a staff will use PPE supplies that will be located right outside of the isolation room when required. Facility has a 30 day supply of PPE on hand. The facility has proper cleaning and disinfectant policies. Facility has a plan in place for when and whom to notify in an outbreak or other emergencies. Facility has conducted training on infection prevention, symptoms, transmission and PPE use. Facility has non-punitive sick leave polices for staff. Sick staff are requested to stay home and not report to work if ill. Activities have been modified to individuals or small groups with social distancing. The facility ensures proper cleaning is done on frequently touched surfaces at least once a day. Sinks were well stocked with soap, paper towels and hand washing signs. Facility does realize guidance changes and the most up to date guidance from CCL-PINS, CDC, CDPH, and local health departments should be followed to remain in compliance. The most stringent orders should be followed by any of these agencies.

Continued on 809-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Diego Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2022
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
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ARC VENTURA COUNTY(ARCADE)
FACILITY NUMBER: 197606385
VISIT DATE: 10/19/2022
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At approximately 12:45 PM, LPA reviewed Department of Social Services, Community Care Licensing Division, Licensing Information System (LIS), Facility Personnel and facility staff roster and determined that all staff are fingerprint cleared and associated to the facility

No deficiencies observed during the visit and all infection control protocols are implemented and are being followed.



Exit interview completed and copy of report emailed to Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Diego Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC809 (FAS) - (06/04)
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