197609056-4-13-2022-29-AS-BBAI-CDFQAC-20220413115942

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609056
Report Date: 04/13/2022
Date Signed: 04/13/2022 12:02:38 PM

Document Has Been Signed on 04/13/2022 12:02 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:	EASTER SEALS SOUTHERN CALIFORNIA VAN NUYS		FACILITY NUMBER:	197609056
ADMINISTRATOR:	FERNANDEZ, CYNTHIA		FACILITY TYPE:	775
ADDRESS:	16605 SHERMAN WAY		TELEPHONE:	(818) 388-7428
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91406
CAPACITY: 50		CENSUS: 3	DATE:	04/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Cynthia Fernandez - Administrator		TIME COMPLETED:	12:00 PM

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Licensing Program Analysts (LPA) Brian Balisi conducted an unannounced required annual visit. This annual had a specific emphasis on infection control practices and procedures. Upon arrival LPA met Administrator Cynthia Fernandez and Carlos Guillen Program Director and explained the reason for the visit.

The LPA, along with Carlos toured the physical plant areas inside and outside at approximately 10am to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. There were (3) clients inside the facility participating for services. Administrator stated majority of clients participate with the program via zoom.

Kitchen appliances appeared to be in operable condition at this time. The facility has a sufficient supply of perishable and non-perishable food properly stored. 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 108 - 113 degrees Fahrenheit.

In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and office furniture were observed to be in good condition. Chairs were observed to be at least 6 (six) feet apart for social distancing. The LPA observed the required postings throughout the facility. Fire extinguishers were observed to be serviced within the last year. Carbon / Fire detectors were also observed to be working at the time of visit. LPA observed a large open area in which program activities are provided, as well as multiple multi-function rooms and offices. Furniture's were observed in good repair. Other equipment used for activities appears to be in adequate condition. At approx 11:15am, LPA observed staff conducting zoom classes in one of the offices. LPA did not observe any obstructions or hazards during the visit.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

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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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: EASTER SEALS SOUTHERN CALIFORNIA VAN NUYS	FACILITY NUMBER: 197609056
	VISIT DATE: 04/13/2022

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Continued from 809

There is a shaded patio in the rear of the facility next to the parking lot. LPA observed outdoor furniture appropriate for outdoor use. There is a gate that surrounds the exterior of the building and parking lot. LPA observed gate to be open at this time. LPA did not observe any obstructions to exits at this time.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator 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.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

LIC809 (FAS) - (06/04)

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