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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608493
Report Date: 06/01/2023
Date Signed: 06/01/2023 11:55:10 AM

Document Has Been Signed on 06/01/2023 11:55 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:UNIVERSAL DAY PROGRAM 2FACILITY NUMBER:
197608493
ADMINISTRATOR:AREVIK MATEVOSIANFACILITY TYPE:
775
ADDRESS:8847 LANKERSHIM BL.TELEPHONE:
(747) 223-2350
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 128CENSUS: 77DATE:
06/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Suzie Hastings, Program DirectorTIME COMPLETED:
12:00 PM
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On 06/01/02023 at around 9:50 AM, LPA Duguma conducted a Case Management visit to the facility, met with Suzie Hastings and explained the reason for the visit.

On 05/24/2023 at around 9:30 AM, Client #1's (C1) mother reported that Staff #1(S1) was sending inappropriate texts to C1. On 05/24/2023 at around 12:00 PM, S1 was issued a final paycheck and terminated for Violation of Policy/Consumer Abuse and Sexual Harassment. On 05/24/2023 at around 5:00 PM, an Incident Report was filed by the facility regarding inappropriate behavior between Client #1 (C1) and Staff #1 (S1).

On 05/25/2023 at 9:30 AM, LPA Duguma contacted the facility and spoke with supervisor Selva Banos who stated that S1 was immediately terminated, and an updated SOC 341 will be sent to the police department and the Department of Developmental Services. Banos also stated that C1's mother sent screen shots as proof of inappropriate communication. On 05/25/2023 at around 10:20 AM, screen shots were emailed to LPA Duguma. Later that day at around 2:20 PM, Program Director Suzie Hastings reported that a police report was filed, and an email of the report was forwarded to LPA Duguma. Hastings added that C1 received training in Special Incident Reporting, Sexual Harassment, Zero Tolerance Policy and Documentation/Note Taking.

During the visit, at around 10:20 AM, LPA requested copies of employment termination and proof of employee training. LPA Duguma inquired about whether S1 is employed at any other facility associated with Universal Day Program 2 and Hastings replied, "No, not with us or any other company that we work with, but I do believe that S1 might be working at another day program called Naslund and Naslund Foundation." Hastings added that on 05/08/2023, S1 gave a two week notice and during termination stated, "I was leaving anyway, and it takes two to tango".
(CONT. on LIC809-C)
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2023
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: UNIVERSAL DAY PROGRAM 2
FACILITY NUMBER: 197608493
VISIT DATE: 06/01/2023
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Hastings provided contact information for Naslund and Naslund Foundation. C1 is living at home with parent. LPA Duguma requested copies of C1's file and a copy of C1's Physician's Report and Needs and Service Plan.

Based on interviews and record review, the facility took all necessary measures, therefore, no citations will be issued at this time.

No further action at this time.

No health and safety hazards noted during the visit.

Exit interview conducted and copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
LIC809 (FAS) - (06/04)
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