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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801424
Report Date: 01/29/2024
Date Signed: 01/29/2024 01:40:17 PM

Document Has Been Signed on 01/29/2024 01:40 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: 42DATE:
01/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Josephe LaporteTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced for a required one-year annual inspection today. The last annual conducted at this facility was on 02/22/2023. Upon arrival, LPA met with Program Director, Joseph Laporte and Case Manager, Brianne Esseff, at this time the reason for the visit was explained. Entrance Interview.

At 10:25 a.m., the LPA along with the Program Director and Case Manager, toured the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted during the plant tour:

The day program operates Monday through Friday from 9:00 a.m. to 3:00 p.m. There are fifty – one (51) participants, and twenty (20) program staff present today. The day program is currently staffed appropriately with the necessary staff to participant ratios of 1:4 and 1:1. The facility has six (6) activity rooms, several offices, and a kitchen/cafeteria area.

Common Areas: At 10:28 a.m., the LPA observed the kitchen/cafeteria area. Kitchen appliances appeared clean and were in operable condition at the time of the visit. There are several fire extinguishers throughout the facility; they all were fully charged and were last serviced 08/15/2023. Carbon monoxide detectors are wired and operational at the time of the visit. The last fire inspection was completed on 06/11/2023 and was found to be in compliance with Fire Code Regulations at the time of inspection. Fire and earthquake drills conducted within the last 6 months as per regulation; the last one conducted 1/19/2024.

(Report Continued on LIC 809...)

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2024
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: 01/29/2024
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(Report Continued from LIC 809...)

No bodies of water noted at the time of the visit. Activities are both designed for both as individuals and as a group. The LPA observed staff interacting with participants during time of visit. Equipment used for activities was in good condition at the time of the visit. No obstructions or hazards were observed inside or out.

Bathrooms: There are seven (7) restrooms for participant use. Restrooms were clean and sanitary. The LPA observed trash cans with lids to protect participants from cross contamination. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature was measured in restrooms, and they measured between 106.8- and 107.2-degrees Fahrenheit at the time of the visit.



File Review: Records review began at 11:06 a.m.; five (5) participant records were reviewed for the following: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, Individual Program Plans (IPP), and current needs and services plan. All participant records were in order. The LPA reviewed five (5) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, and valid first aid/CPR. Training records on file. All staff records were in order.

At the time of the visit, the LPA obtained the following documents: LIC 500 Personnel Report, Census, and a copy of the certificate of liability insurance.

Medications: Medications review began at approximately 10:50 a.m. Medications are centrally stored and locked inside a cabinet inside the manager’s office. All medications including PRNs were labeled, stored and locked inaccessible to participants. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during medications review.



No citations issued. Exit interview conducted. The report was reviewed, and a copy was provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024
LIC809 (FAS) - (06/04)
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