<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607709
Report Date: 08/29/2023
Date Signed: 08/29/2023 11:56:09 AM

Document Has Been Signed on 08/29/2023 11:56 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA VALLEY HOMEFACILITY NUMBER:
197607709
ADMINISTRATOR:VEGA TAPIA, DANNYFACILITY TYPE:
735
ADDRESS:1217 N VALLEY STTELEPHONE:
(818) 846-0032
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 3CENSUS: 3DATE:
08/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sabrina Swofford-Godinez and Priyanka SamarakoonTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Manager (LPM) Naira Margaryan and Licensing Program Analyst (LPA) Antonia Alvizar conducted an unannounced Case Management visit to the facility. The purpose of today’s visit was to serve the Order of Immediate Exclusion from Facility for Staff #1 (S1) and staff #2(S2). Prior to this visit Community Care Licensing Department (CCLD) conducted an investigation and it was determined that S1 and S2 violated California Code of Regulations Title 22 for personal rights.

On today's visit LPM and LPA met with Administrator, Sabrina Swofford-Godinez and Priyanka Samarakoon and explained the reason for the visit. Administrator was served an Immediate Exclusion Order for S1 and S2. The Administrator informed LPM and LPA that S2 never worked for the facility.

At the time of visit, S1 was present and LPM and LPA served an Immediate Exclusion letters to S1. The Government Code 11522 was attached to the exclusion order. S1 was removed from the facility after receiving an Exclusion Order.

No immediate Health and Safety Hazard was noted during this visit,

Exit interview held. A copy of the report was provided to the Administrator.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1