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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608442
Report Date: 07/15/2024
Date Signed: 07/15/2024 02:21:04 PM

Document Has Been Signed on 07/15/2024 02:21 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:SVS VAN NUYSFACILITY NUMBER:
197608442
ADMINISTRATOR/
DIRECTOR:		MAGDALENA GALVEZFACILITY TYPE:
775
ADDRESS:14547 ERWIN STREETTELEPHONE:
(818) 849-3021
CITY:VAN NUYSSTATE: CAZIP CODE:
91411
CAPACITY: 45CENSUS: 21DATE:
07/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Magdalena "Maggie" GalvanTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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At 10:00 A.M. Licensing Program Analysts (LPA) Valeria Conway conducted an unannounced required annual visit. Upon arrival LPA met Program Director Magdalena “Maggie” Galvez and explained the reason for the visit. All clients are vendored by the North Los Angeles Regional Center.

The LPA, along with Maggie toured the physical plant areas inside and outside at approximately 10:15 A.M. 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. Ground floor also has an activity room, Computer Lab, Library, Lounge, Conference room, Arts & Crafts room, Quiet room, Cooking/kitchen room and three (3) bathrooms with three (3) washbasins, Second floor is for Program Director and four (4) other staff offices, no clients permitted. LPA toured and inspected both floors, no deficiencies were noticed.

The kitchen appeared clean and the appliances and fixtures functional during the time of visit. Additionally, LPA observed a sufficient amount emergency water under the kitchen sink. At 10:26 A.M. hot water measured at 111.2 degrees Fahrenheit. Also, 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 locked storage room with cleaning supplies and other toxins PPE equipment, and emergency supplies made inaccessible to clients. First aid kits were observed with guide and all required items. Facility does not handle any medications or cash for participants/clients at this time.

Continued on LIC 809-C
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2024
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SVS VAN NUYS
FACILITY NUMBER: 197608442
VISIT DATE: 07/15/2024
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Continued from LIC 809

Public restrooms were observed to be clean and sanitary and in operating conditions. The LPA observed sufficient amounts of soap and paper products in each restroom, as well as hand washing posters. Toilets were observed to be operable. Hot water in all three (3) public restrooms measuring between 105 - 120 degrees Fahrenheit at the time of the visit.

The LPA observed the required postings throughout the facility. Additionally, this facility is equipped with sprinkler system which was last serviced by the Los Angeles Fire Department on 08/25/2023 with an expiration date of 05/30/2025. Fire extinguishers were observed to be fully charged and last serviced in 05/01/2024. Carbon/Fire detectors were also observed to be working at the time of visit. Facility smoke detectors were last tested on 05/24/2024. Emergency drills are conducted monthly, last Emergency Drill conducted on 06/10/2024 was for Heat Illness.



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 on hallways, stairways nor exits 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.

LPA began record reviewing including personnel and client records at 12 P.M. Five (5) client files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, 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 obtained copies of the following: Activities schedule, staff schedule, resident roster, liability insurance, car insurance and last emergency drill.

No deficiencies were cited. Exit interview conducted and copy or report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC809 (FAS) - (06/04)
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