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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800253
Report Date: 09/14/2022
Date Signed: 09/14/2022 02:24:26 PM

Document Has Been Signed on 09/14/2022 02:24 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:ASSOCIATION FOR RETARDED CITIZENS - VENTURAFACILITY NUMBER:
565800253
ADMINISTRATOR:MITCHEL GARCIAFACILITY TYPE:
775
ADDRESS:3340 E. LOS ANGELES AVENUETELEPHONE:
(805) 527-1358
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 90CENSUS: 20DATE:
09/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Mitchel GarciaTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Zabel Chochian conducted an unannounced Required -1 Year inspection. LPA met with Administrator Mitchel Garcia. Upon arrival LPA was informed that a staff reported testing positive yesterday evening. Administrator provided information regarding positive case via email during todays visit.

LPA and Administrator toured the facility at approximately 1:15pm to inspect for infection control practices in place. LPA observed one central entry point at the front of the building designated for staff, clients and visitors universal entry screening. Sanitary and cleaning supplies were observed sufficient. Infection control practices discussed with Administrator. An inspection of the common areas, client rooms and restrooms were conducted. Required signage/postings observed through out the facility; restrooms observed sanitary and in operating condition with toilet paper, soap and paper towels. Sufficient supply of Personal Protective Equipment (PPE) observed.

No citations issued during today's visit.

Exit interview conducted. Copy of today's report was emailed to the Administrator.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2022
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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