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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421701729
Report Date: 04/29/2022
Date Signed: 04/29/2022 12:26:44 PM

Document Has Been Signed on 04/29/2022 12:26 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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:VTC ENTERPRISESFACILITY NUMBER:
421701729
ADMINISTRATOR:JASON TELANDERFACILITY TYPE:
775
ADDRESS:2445 A STREETTELEPHONE:
(805) 928-5000
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 150CENSUS: 26DATE:
04/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Cyrstal SmithTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Toan Luong conducted an unannounced One Year Infection Control Annual visit to the facility. LPA met with Manager Crystal Smith and explained the purpose of the visit.

LPA was screened at the entrance and toured the adult day program. The facility has 2 main entrances on the same side of the building. One entrance is for clients entering the day program, and one for staff to enter the administration wing of the facility. Both entrances have a temperature and symptom screening along with a sign in sheet. Hand sanitizer is provided at both entrances. During LPA's tour, LPA observed clients socially distancing from each other, and all staff were wearing face coverings. At 11:20 a.m., LPA discussed items in the Infection Control Module and noted that staff have not been fit tested with N95 masks. All other items in the Infection Control Module was checked as yes. Infection Control Module was addressed with Manager to satisfaction.

LPA conducted exit interview with Manager and emailed a copy of today's report and appeal rights to the Manager.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Toan Luong
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2022
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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