565801424-2-3-2025-29-AS-MARO-DDJUSA-20250203145002

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801424
Report Date: 02/03/2025
Date Signed: 02/03/2025 02:51:00 PM

Document Has Been Signed on 02/03/2025 02:51 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-COCHRAN		FACILITY NUMBER:	565801424
ADMINISTRATOR/ DIRECTOR:	JOSEPH A LAPORTE		FACILITY TYPE:	775
ADDRESS:	5143 COCHRAN STREET		TELEPHONE:	(805) 520-0399
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93063
CAPACITY: 90		CENSUS: 49	DATE:	02/03/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Joseph Laporte		TIME VISIT/ INSPECTION COMPLETED:	03:00 PM

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Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced for a required one-year annual inspection today. Upon arrival, the LPA met with Program Director, Joseph Laporte and explained the reason for the visit. Entrance Interview.

Starting at 9:50am, the LPA along with the Program Director 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 observed:

The day program operates Monday through Friday from 9:00am to 3:00pm. There are forty-nine (49) participants, and nineteen (19) program staff present today. The day program is currently staffed appropriately with the necessary staff to participant ratios. The facility has five (5) activity rooms, several offices, and a kitchen/cafeteria area.

Kitchen / Cafeteria At 9:55am, the LPA observed the kitchen/cafeteria area. Kitchen area was clean, and appliances appeared to be in operable condition. Refrigerator and dry food pantry were checked for proper labels and expiration dates. Expiration dates were clearly marked at the time of the visit.

Activity Rooms: Activity rooms were observed to be furnished appropriately and all furniture was observed to be in good condition at the time of the visit. The facility maintained a comfortable temperature.

Report Continued on LIC 809C...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025

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: 02/03/2025

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Report Continued from LIC 809...

The LPA observed required postings throughout the common space. 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. Cleaning supplies were observed locked and inaccessible at the time of the visit. No obstructions or hazards were observed inside or out.

Bathrooms: There are six (6) 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. Starting at 9:58am, the hot water temperature was measured in participant restrooms, and they measured between 114.6 and 116.2 degrees Fahrenheit.

Outdoors: There is a shaded area with appropriate furniture for participant use. The exterior passageways were clean and clear of any obstructions in case of an emergency. The LPA observed two (2) side gate that latches. No bodies of water noted at the time of the visit.

File Review: Records review began at 10:32am; ten (10) 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 ten (10) 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.

Infection Control / Emergency Disaster Training: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate.

Report Continued on LIC 809C...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025

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: 02/03/2025

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Report Continued from LIC 809C...

There are several fire extinguishers throughout the facility; they all were fully charged and were last serviced 09/17/2024. Carbon monoxide detectors are wired and operational at the time of the visit. The last fire inspection was completed on 10/01/2024 and was found to be in compliance with Fire Code Regulations at the time of inspection. Fire and earthquake drills conducted quarterly as per regulation; the last one being a fire drill which was conducted on 01/24/2025.

Medications: Medications review began at approximately 2:10m. 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 appeared to be given as prescribed at the time of the visit.

No citations issued. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025

LIC809 (FAS) - (06/04)

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