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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800867
Report Date: 12/22/2022
Date Signed: 12/22/2022 04:06:30 PM

Document Has Been Signed on 12/22/2022 04:06 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:ARC-HERITAGE VALLEYFACILITY NUMBER:
565800867
ADMINISTRATOR:SONIA SALINASFACILITY TYPE:
775
ADDRESS:116 NORTH 10TH STREETTELEPHONE:
(805) 933-9029
CITY:SANTA PAULASTATE: CAZIP CODE:
93060
CAPACITY: 90CENSUS: 25DATE:
12/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:08 PM
MET WITH:Katie GomezTIME COMPLETED:
01:35 PM
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Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual visit at 12:08 p.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator/Program Manager Katie Gomez who has been the administrator since August of 2022. LPA explained the reason for the visit. The LPA, along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. RESTROOMS: Three restrooms were observed to be clean and sanitary and in operating condition. The showers were in operating condition. The LPA observed sufficient amounts of soap and paper products in each restroom, as well as hand washing posters and hand sanitizers in the restrooms and throughout the facility. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating areas and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common hallway. Fire extinguishers were observed to be serviced within the last year. Carbon monoxide detector and smoke alarms were tested and functioned properly at the time of visit. The outdoor patio has a covered area equipped with furniture for client use. Laundry room contains a locked storage cabinet for laundry supplies. KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food and water. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. The facility has a central entry point for symptom screening. The LPA observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The medications are locked and there appears to be a sufficient supply of medication for client use. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. No citations were issued during today’s visit. Exit interview conducted. A copy of the report was provided via email.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2022
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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