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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609928
Report Date: 04/04/2022
Date Signed: 04/04/2022 12:42:45 PM


Document Has Been Signed on 04/04/2022 12:42 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., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:COVELLO TOP NOTCH CARE LLCFACILITY NUMBER:
197609928
ADMINISTRATOR:LOPEZ, DAVIDFACILITY TYPE:
740
ADDRESS:18807 COVELLO STREETTELEPHONE:
(818) 855-9615
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 4DATE:
04/04/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:David LopezTIME COMPLETED:
11:15 AM
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At 11:00 a.m. on 04/04/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced Plan of Correction (POC) visit. LPA met with Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out.

At 11:05 a.m. LPA observed 9 out of 9 auditory devices functioning properly at the front entrance gate, front door, back exit gate, front door, kitchen exit, Bedroom #1, Bedroom #2, Bedroom #4, and Bedroom #5.

On 03/16/2022 licensee submitted proof of training on infection control policies to LPA at the Woodland Hills Regional Office. Training was conducted on 03/16/2022 at 8:30 a.m. 5 out of 5 staff attended the training.

Deficiencies are cleared. Exit interview conducted. POC letter generated. A copy of report issued.

SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2022
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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