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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606451
Report Date: 02/08/2023
Date Signed: 02/08/2023 10:52:07 AM

Document Has Been Signed on 02/08/2023 10:52 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:PARTNERS FOR POTENTIAL, INC.FACILITY NUMBER:
197606451
ADMINISTRATOR:LISA ANN WILLIAMSENFACILITY TYPE:
775
ADDRESS:6255 VAN NUYS BOULEVARDTELEPHONE:
(818) 997-0819
CITY:VAN NUYSSTATE: CAZIP CODE:
91401
CAPACITY: 60CENSUS: 0DATE:
02/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Lisa Ann Williamsen, Administrator TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:46 a.m., the LPA met with the Administrator and explained the reason for the visit. This annual had a specific emphasis on infection control practices and procedures. The day program currently does not have consumers inside the facility. The day program is operating its normal hours for consumers of 8:00 a.m. to 2:00 p.m. through in person learning and community outings.

At 10:14 a.m., the LPA, along with the Administrator toured the physical plant areas inside to ensure there are no health and safety hazards. COMMON AREAS: The LPA observed the conference/rest area to be relatively clean and properly furnished. The LPA observed the fire extinguishers to be fully charged and last serviced on 11/03/2022. KITCHEN: The LPA observed the kitchen area/ staff room. Cleaning solutions, toxins, chemicals and other hazardous items were inaccessible and locked away in the staff room/ kitchen. At 10:19 a.m., hot water measured at 107.4-degree Fahrenheit. CLASSROOM/OFFICES: The LPA observed offices and the classroom, which were observed to have the required furniture and supplies. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition. At 10:18 a.m., the hot water measured at 111.8-degree Fahrenheit. Signs are posted throughout all four (4) bathrooms to promote handwashing. OUTDOOR SPACE: Passageways and stairs to the lobby were free and clear from obstruction. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. The LPA observed a 30-day supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient.

No deficiencies were observed at this time. Exit interview conducted. A copy of the report was provided via email and print.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2023
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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