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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610342
Report Date: 04/02/2024
Date Signed: 04/03/2024 09:01:26 AM

Document Has Been Signed on 04/03/2024 09:01 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:STAR VIEW OLIVE VIEW UCLA CRTFACILITY NUMBER:
197610342
ADMINISTRATOR:LOZANO, AIDA YVONNEFACILITY TYPE:
772
ADDRESS:14139 BUCHER AVENUETELEPHONE:
(818) 209-5309
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY: 16CENSUS: 0DATE:
04/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:21 AM
MET WITH:Victoria MelnikovaTIME COMPLETED:
02:45 PM
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Licensing Program Analysts (LPAs) Raymond Comer, Jose Gary Tan, and Michael Cava, conducted an Annual Required visit and inspection of this facility today and met with Administrator, Victoria Melnikova, and explained the reason for the visit. At approximately 11:45 AM, a tour of the physical plant was done with the Administrator. Facility is currently not operating at this time.

Infection Control: There is only one entrance being utilized at the facility, the front main entrance door. The two (2) side doors are for emergency only. There are required poster posted at the main door. Screening area is located immediately upon entrance in the reception area. All visitors/resident and staff are required to sign. There is also a sign in sheet, hand sanitizer, gloves and masks available. The facility had submitted and approved Mitigation plan.

There are hand sanitizers stocked and accessible all over the facility. There are signs to wear a mask and other COVID prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in common bathrooms, elevators and all over the common areas of the facility. The facility have multiple designated visitors' area spaces in the front entrance. The facility has sufficient stock of PPE in the storage room.

The facility is fire cleared for sixteen (16) ambulatory and two (2) non-ambulatory residents. This is a short term crisis residential facility. There are fire extinguishers all over the facility and last inspected on 12/16/23. The facility is equipped with sprinkler system. The facility temperatures was set at 72°F. The smoke alarm are hard wired and interconnected and last tested on 11/20/23. Fire and sprinkler inspection was done on 06/30/23. There is a carbon monoxide installed in the facility.

Kitchen: The kitchen appeared clean and the appliances and fixtures functional.
(continued on LIC 809-C)
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE: DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: STAR VIEW OLIVE VIEW UCLA CRT
FACILITY NUMBER: 197610342
VISIT DATE: 04/02/2024
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(continued from LIC 809)

Bedrooms: Personal accommodations in resident bedrooms were observed for safety, privacy, and comfort. Random resident rooms were inspected and observed with all required furnishings. There are a total of nine (9) bedrooms in the facility, five (5) on the ground floor and four (4) on the 2nd floor, all except for the two (2) ADA rooms are shared.

Bathrooms: There are six (6) total common bathrooms in the facility. Three (3) on the ground floor and three (3) on the 2nd floor. They were properly supplied and had functional fixtures. Hot water temperature in common bathrooms were checked and measured at a range of 108.1 F to 110.2°F and within the required range.

Common Areas: Common areas, including the activity rooms, dining rooms and offices appeared clean and were properly furnished. There are also three (3) laundry rooms in the facility, two (2) are located in the ground floor and one (1) on the 2nd floor. Laundry soap and other cleaning agents were observed locked in the laundry room and janitor's closet.

Surrounding Grounds: Entry/exits were free of obstruction. The outdoor area was clean and free of hazards. There is no body of water in the facility.

Resident Files: There are no residents at the facility at this time.

Staff Files: There are no Staff working at the facility at this time.

Medications: A locked medications cart on site and inaccessible to residents. There is a First aid kit located in the medication room and one (1) in the kitchen.

There is no health and safety issue observed during this visit. Exit Interview Conducted and a Copy of this Report Issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
LIC809 (FAS) - (06/04)
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