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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801424
Report Date: 02/25/2022
Date Signed: 02/25/2022 02:22:12 PM

Document Has Been Signed on 02/25/2022 02:22 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ARC VC-COCHRANFACILITY NUMBER:
565801424
ADMINISTRATOR:KARIE RAGANFACILITY TYPE:
775
ADDRESS:5143 COCHRAN STREETTELEPHONE:
(805) 520-0399
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 90CENSUS: 26DATE:
02/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Joe Laporte - Program ManagerTIME COMPLETED:
02:30 PM
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Licensing Program Analysts (LPA) Brian Balisi conducted an unannounced required annual visit. This annual had a specific emphasis on infection control practices and procedures. Upon arrival LPA met with Program Manager Joe and explained the reason for the visit.

The LPA, along with Program Manager and Assistant Supervisor Brianne Esseff toured the physical plant areas inside and outside at approximately 12pm to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations.

RESTROOMS: Public restrooms were observed to be clean and sanitary and in operating condition. The showers were in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products in each restroom, as well as hand washing posters.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. Chairs were observed to be at least 6 (six) feet apart for social distancing. LPA also observed plastic dividers on each table. The LPA observed the required postings in the common hallway. Fire extinguishers were observed to be serviced within the last year. Carbon dioxide detector was also observed to be working at the time of visit.

The outdoor patio has a covered area equipped with furniture for client use. There were no bodies of water noted. LPA observed multiple sheds in the surrounding grounds. LPA observed each shed to be locked and inaccessible to clients. Staff opened each shed and LPA observed various supplies for gardening and activities.

Continued on LIC 809-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ARC VC-COCHRAN
FACILITY NUMBER: 565801424
VISIT DATE: 02/25/2022
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Continued from 809

KITCHEN: Kitchen appliances appeared to be in operable condition at this time. The facility has a sufficient supply of perishable and non-perishable food properly stored. 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 Program Managerregarding the facility’s infection control practices. Upon entry, the facility has a 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 LPA also observed a sufficient supply of medication for client use. The facility’s cleaning protocol is sufficient. At 11:55am, LPA observed staff sanitizing all high traffic touch areas. 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 to Program Manager.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022
LIC809 (FAS) - (06/04)
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