197608493-12-12-2023-31-AS-CALH-CYG3BZ-20231212170711

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608493
Report Date: 12/12/2023
Date Signed: 12/12/2023 05:09:55 PM

Document Has Been Signed on 12/12/2023 05:09 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	UNIVERSAL DAY PROGRAM 2		FACILITY NUMBER:	197608493
ADMINISTRATOR:	AREVIK MATEVOSIAN		FACILITY TYPE:	775
ADDRESS:	8847 LANKERSHIM BL.		TELEPHONE:	(747) 223-2350
CITY:	SUN VALLEY	STATE: CA	ZIP CODE:	91352
CAPACITY: 128		CENSUS: 60	DATE:	12/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Suzie Hastings		TIME COMPLETED:	03:08 PM

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Licensing Program Analyst LPA Christopher Alemoh, met with Suzie Hastings Program Director for an annual visit at 08:30 am. Today’s visit will include inspection of physical plant, and review of facility client and staff records, overall operation of the facility, including but not limited to facility policies and procedures. Entrance interview conducted. The facility has COVID-19 and hand washing signs; Posted throughout the facility.

At the time of visit the facility Census is 60 clients.

At 08:50 am LPA toured the physical plant with Director, to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

The facility is a Day Program which operates from 8:30AM to 2:30 PM.

This facility is licensed to serve 98 Ambulatory and 30 non ambulatory. Client groups served Adults. Total capacity is 128 clients.

The facility consists of designated classrooms such, a computer room, exercise room, resting room with two beds for clients use, kitchen, common areas, conference room, reception area, multi-purpose room and several offices throughout the facility for staff use. All rooms, common areas and the offices were inspected and observed appropriately furnished.There is one office space located on the second floor with storage room and attic area.There are five (5) restrooms (four of the restrooms are with two toilets and two washbasins; one restroom is a single with shower area). Water temperature in the bathrooms measured at 115- and 116-degrees F. and toilets observed functioning normal.

LPA observed the facility has a full kitchen. Food is stored between two refrigerators. Items in the refrigerator are all dated and labeled. All sharps, solutions, and chemicals are stored in a cabinet under the sink. LPA observed this area to be clean and all appliances are in good working order. Clients bring their lunch to the facility 4 days per week and alternate cooking meals at the facility once per week. The facility does not handle and client medications or personal and incidental funds.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: UNIVERSAL DAY PROGRAM 2	FACILITY NUMBER: 197608493
	VISIT DATE: 12/12/2023

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At 10:15 AM LPA reviewed random 6 staff files for staff present during visit, all were observed to be complete and current at this time. LPA reviewed 10 client files, all were observed to be complete and current at this time.

Three (3) fire extinguishers observe throughout the facility the charge date is May 5^th, 2024. Smoke Alarm/Carbon monoxide detectors, and sprinkler system are hardwired and operational. The fire inspection was completed by the Los Angeles Fire Department and was found to be in compliance with Fire Code Regulations at the time of inspection.

Facility temperature is kept at 71 degrees Fahrenheit. No bodies of water.

Fire and earthquake drills conducted within the last 6 months were on 07/25/2023 as per regulation.

No deficiencies cited.

Exit interview conducted. A copy of this report and appeal rights was left with Administrator Program Director Suzie Hastings.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC809 (FAS) - (06/04)

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