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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600200
Report Date: 09/28/2023
Date Signed: 09/28/2023 12:22:25 PM

Document Has Been Signed on 09/28/2023 12:22 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
Lookup Error,
, CA
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: 33DATE:
09/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH:Emma Pinto and Arevilk Matevosian, Administrator TIME COMPLETED:
12:29 PM
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Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced annual inspection at the facility. Upon arrival, LPA met with Emma Pinto and Administrator Arevilk Matevosian arrived a short time later and explained the purpose of the visit. The facility is licensed to serve 60 developmentally disabled adults. Forty (40) ambulatory and 20 can be non-ambulatory. Hours of operation M-F 9am to 2 PM.

LPA use the CARE tool for this visit.

LPA observed the following:

Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents. Disposals of trash are done immediately. Staff are still cleaning and disinfecting throughout the day. Sufficient PPE supplies and has an Infection Control Plan posted by the entrance.
Physical Plant & Environment Safety: Facility is a one story building. The program consists of 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 9/8/2023. The facility's last fire inspection was conducted in 2023 by City of LA Fire Department.
Operational Requirements: The facility has plan to accept or retain clients with developmental disabilities. The facility has enough liability insurance covering injury to residents and guest.
Staffing: There appears to be sufficient staffing at the facility. The Administrator’s Arevilk Matevosian certificate expires 07/31/2023. Staff employed are all over the age of 18.
Personnel Records-Training: Staff files are maintained at the facility. Staff have current CPR/Frist Aid training and evidence of on-going training.

(continued on 809C)
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2023
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: UNIVERSAL DAY PROGRAM,INC.
FACILITY NUMBER: 198600200
VISIT DATE: 09/28/2023
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Client Records-Incident Reports: Client files are maintained at the facility and have the following documents in their files - Admission Agreements, Face sheet and other required documentation, Including up to date IPP and needs and services plan
Client Rights-Information: The Complaint poster and personal rights are posted by the main entry.
Food Service: No food is served or stored at facility.
Health-Related Services: All staff have current CPR/first aid training.
Incidental Medical Services: No medications are stored or administered at facility.
Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Staff require up to date training on utility shut off.
Emergency Intervention: NA

During the visit today, LPA observed no deficiencies. Technical advisories provided.

An exit interview was held. A copy of this report, technical advisory notes, and appeal rights were given to Administrator Arevilk Matevosian

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
LIC809 (FAS) - (06/04)
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