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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600200
Report Date: 03/09/2022
Date Signed: 03/09/2022 01:30:16 PM

Document Has Been Signed on 03/09/2022 01:30 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:UNIVERSAL DAY PROGRAM,INC.FACILITY NUMBER:
198600200
ADMINISTRATOR:AREVIK MATEVOSIANFACILITY TYPE:
775
ADDRESS:4219 WEST BURBANK BLVD.TELEPHONE:
(818) 848-5236
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 60CENSUS: 9DATE:
03/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:51 AM
MET WITH:Arevik Matevosian, AdministratorTIME COMPLETED:
01:35 PM
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Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA explained the purpose of the visit to Administrator Arevik Matevosian. The Day Program is licensed to serve 60 developmentally disabled adults ages 18- 59 [40 Ambulatory & 20 Non-Ambulatory]. During the today's visit, LPA toured the physical plant. The facility provides transportation services and is equipped with 5 vans. Administrator certificate expires 7/31/2022.

Physical Plant: Facility is a one story building. The program consists 1 conference room, 2 staff offices, 1 resting area room, 1 classroom, 1 locker/storage room, 1 exercise room, 1 computer room, 1 kitchen, 3 restrooms, 1 common area room, storage room, lobby area, and outdoor shaded patio area. The last disaster drill was conducted on 1/17/2022. The facility's last fire inspection was conducted in 2021 by City of LA Fire Department.
  • Programming is in place with limited client occupancy.
  • COVID-19 Infection Control screening, signs to promote hand washing, cough/sneeze etiquette, and physical distancing were observed in the entrance, common areas, hallways, and bathrooms. Facility has an approved COVID-19 mitigation plan.
  • Disinfectant products are locked and inaccessible to clients.
  • Restrooms have sufficient soap and posted hand washing signs.
  • No medication records were reviewed. Facility does not administer medications.
  • The Resting Room will be used as an COVID-19 isolation room if needed.
  • Personal Protective Equipment (PPE's) of more than 30 days were observed.
  • Staff were observed wearing masks. Due to cognitive disability clients were not wearing masks.
  • A posted Emergency Disaster Plan and emergency food supply and water were observed.
No deficiencies were cited.
Exit interview was conducted with Administrator Arevik Matevosian. A copy of the report was provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2022
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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