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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801215
Report Date: 02/22/2023
Date Signed: 03/13/2023 11:18:50 AM


Document Has Been Signed on 03/13/2023 11:18 AM - 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:ANGELS IIFACILITY NUMBER:
565801215
ADMINISTRATOR:JOANN TRUPIANOFACILITY TYPE:
740
ADDRESS:2375 MCDONALD COURTTELEPHONE:
(805) 404-5201
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:6CENSUS: 5DATE:
02/22/2023
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
02:32 PM
MET WITH:Honorata Perla AvestroTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) arrived at the facility unannounced to conduct a required annual visit. The LPA met with staff Honorata Perla Avestro and Magdalena Guansing. Staff contacted Licensee Joann Trupiano. LPA explained the reason for the visit - Annual inspection today emphasis is specifically on infection control practices and procedures.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening and sanitation station. Infection control postings were observed. The facility had an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility has appropriate plans in place in the event of clients and/or staff showing symptoms of COVID or testing positive for COVID.

At approximately 2:45pm, LPA and staff 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. The carbon monoxide and smoke alarms were tested and all functioned properly. The fire extinguisher was last serviced 04/2022. KITCHEN: Knives were found in an unlocked drawer. Other knives and cleaning supplies are stored in a locked cabinet under the sink. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All medications were stored in a locked armoire. BEDROOMS: The LPA observed two single-occupancy resident bedrooms and two shared bedrooms which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: Restrooms are clean and sanitary and in operating condition. Cleaning items are stored in locked cabinets. COMMON SPACES: The living room, family room and dining room furniture were observed to be in good condition. The patio is equipped with furniture for resident use. No bodies of water.

Exit interview conducted. Copy of report provided to Licensee.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel ChochianTELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2023
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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