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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610304
Report Date: 06/07/2022
Date Signed: 06/07/2022 02:06:14 PM

Document Has Been Signed on 06/07/2022 02:06 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:WATKINS VITAL CARE PROGRAMFACILITY NUMBER:
197610304
ADMINISTRATOR:GIACOPUZZI, MALLORYFACILITY TYPE:
775
ADDRESS:3819 OCEAN VIEW BLVDTELEPHONE:
(818) 334-5592
CITY:MONTROSESTATE: CAZIP CODE:
91020
CAPACITY: 15CENSUS: 0DATE:
06/07/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:37 AM
MET WITH:Mallory Giacopuzzi, AdministratorTIME COMPLETED:
02:05 PM
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A Pre-licensing visit was conducted by Licensing Program Analyst (LPA) Rosaura Valenzuela. LPA met with Administrator Mallory Giacopuzzi. A physical plant tour was conducted. The Day Program will serve adults 18 years and older. This is a change of location application.

Fire clearance: Approval received from Los Angeles Fire Department for a capacity of 15.
Structure. The facility is on the first floor of a two story structure. Facility has one program room (Work-room, Computer room, Library, kitchen) and one bathroom. There is staff office space on the second floor.
Bathroom. Water temperature tested at 118 degrees Fahrenheit during the visit.
Hygiene Supplies. Paper towels, toilet paper, and hand soap are in supply.
Emergency Phone Numbers, Exit Plan, Personal Rights. Are all posted.
Phone: There is a working telephone on the premises.
Smoke Detectors. Were tested and functional.
Toxins. Are stored in various locked cabinets.
Kitchen Water Temperature. Hot water tested at 118 F.
Medications, First-Aid Kit. Medications locked and inaccessible to consumers. First Aid Kit is complete.
Hours of Operations: 9:00AM to 3:00PM Monday through Friday.
Food Service: Facility does not have a food service program, however accommodates the dietary needs of each consumer upon request. Consumers bring their own lunch and snacks.
Consumer & Staff Files. Located in a locked file cabinet in the staff office.
Reading Materials, Games, Equipment, TV, Computer & other Materials. There are
books, arts and crafts, movies, puzzles and other recreational materials for the consumers to use.

Exit interview held and copy of report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2022
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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