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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608719
Report Date: 01/21/2022
Date Signed: 01/21/2022 10:40:09 AM

Document Has Been Signed on 01/21/2022 10:40 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:PEOPLE'S CARE BLISS CENTER VALENCIAFACILITY NUMBER:
197608719
ADMINISTRATOR:BENNAGE, CATHERINEFACILITY TYPE:
775
ADDRESS:28720 THE OLD ROADTELEPHONE:
(661) 283-0102
CITY:VALENCIASTATE: CAZIP CODE:
91355
CAPACITY: 45CENSUS: 32DATE:
01/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Corey Kofi Jones, AdministratorTIME COMPLETED:
11:00 AM
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At 9:15am Licensing Program Analyst (LPA), Angela Panushkina, conducted an unannounced annual inspection to this Day Program. LPA was greeted by staff, Diana Hawkins, who granted access to the facility and LPA explained the reason for the visit. Administrator, Kofi Jones, arrived at 9:50am.

Physical tour conducted and LPA observed the following:

Infection control: LPA reviewed the facility mitigation plan (approved on 01/20//2022) to make sure licensee was following current infection control recommendations. Upon arrival, LPA was screened and asked to sign-in the visitors’ log. In addition, LPA was asked all infection control questions. Proper signage was observed inside along the hallway and in the restrooms. Hand sanitizer was also observed. Administrator stated they have sufficient PPE supplies for clients and staff. LPA observed all trash can throughout the facility have fitted lids.

Facility is designed for an adult behavior day program that works with the North Los Angeles County Regional Center. The program operates between 8:00am to 2:00pm. There are several activity rooms ranging from arts and crafts to computers. The clients are provided care and supervision while at the day program. Clients activities schedule is posted along with their personal rights. The staff schedule was reviewed and there is sufficient staff to provide care during operating hours.



Dual smoke and carbon monoxide detectors were located throughout the facility, and at 10:20am they were tested and observed to be operational. The facility conducts fire/emergency drills monthly. There are bathrooms for male and female clients. Bathrooms observed to be clean and functional. The water temperature from kitchen to bathroom sink ranged from 117.8-118.9°F.

No citations issued during this visit. Exit interview conducted. Copy of report provided to the Administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE: DATE: 01/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2022
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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