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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608442
Report Date: 07/21/2023
Date Signed: 07/21/2023 03:44:03 PM

Document Has Been Signed on 07/21/2023 03:44 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:SVS VAN NUYSFACILITY NUMBER:
197608442
ADMINISTRATOR:MAGDALENA GALVEZFACILITY TYPE:
775
ADDRESS:14547 ERWIN STREETTELEPHONE:
(818) 849-3021
CITY:VAN NUYSSTATE: CAZIP CODE:
91411
CAPACITY: 45CENSUS: 12DATE:
07/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Magdalena GalvezTIME COMPLETED:
04:00 PM
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Licensing Program Analysts (LPA) Brian Balisi conducted an unannounced required annual visit.  Upon arrival LPA met Administrator Magdalena Galvez and explained the reason for the visit.

The LPA, along with Galvez toured the physical plant areas inside and outside at approximately 11:50am  to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. 

The facility is a two (2) story industrial structure consisting of a reception area and Case Manager office at the ground floor, Program Director and four (4) other staff offices on the second floor.  Activity room, Computer Lab,  Library, Lounge, Conference room, Arts & Crafts room, Quiet room, Cooking/kitchen room and  three (3) bathrooms with three (3) washbasins are also located on the ground floor.

The facility is equipped with sprinkler system.  First aid kits were observed with guide and all required items.  Storage rooms were observed locked during visit with cleaning supplies and other toxins made inaccessible to clients.  Galvez stated  the facility does not handle any medications or cash for participants/clients at this time.

Kitchen appliances appeared to be in operable condition at this time. LPA observed sufficient room in the fridge for clients to store snacks and beverages.  All knives and cleaning supplies were observed to be inaccessible at time of visit. LPA observed a storage room, which stored PPE, cleaning supplies, emergency supplies, and other facility supplies at this time.

Public restrooms were observed to be clean and sanitary and in operating condition.  The LPA observed sufficient amounts of soap and paper products in each restroom, as well as hand washing posters. Hot water measured between 105 - 120 degrees Fahrenheit.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2023
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SVS VAN NUYS
FACILITY NUMBER: 197608442
VISIT DATE: 07/21/2023
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Continued from 809
The LPA observed the required postings throughout the facility. Fire extinguishers were observed to be fully charged and last serviced in May 5,  2023.  Carbon / Fire  detectors were also observed to be working at the time of visit. Emergency drills are conducted monthly. Furniture in each activity  room  were observed and  in good repair. Other equipment used for activities appears to be in adequate condition at this time.  LPA did not observe any obstructions or hazards during the visit.
Outside area was observed free of clutter and obstruction with a community garden to the left of the exit door.  Parking is located at the back of the building gated with metal bar fence. The vehicles used for client transportation are properly registered and current at this time.
INFECTION CONTROL: During today’s visit, the LPA spoke with  Galvez  regarding  the facility’s infection control practices. Upon entry, the facility has a single entry point for symptom screening. The LPA observed an adequate supply of Personal Protective 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’s policies and procedures as it pertains to infection control are adequate at this time.
Exit interview conducted. Report issued and sent via email.
Records: LPA began reviewing Personnel and Client Records at 12:45pm. Five (5) client files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records appeared to be in order. Six (6) personnel files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records appeared to be in order.

LPA conducted staff interviews at approximately 01:00pm. All clients left the facility at approx. 1pm.

Last Emergency Drill conducted on 06/08/2023 for Heat Illness.

During today’s visit, the LPAs obtained copies of the following: staff roster, staff schedule, and resident roster.

Exit interview conducted and copy or report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
LIC809 (FAS) - (06/04)
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