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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801684
Report Date: 11/22/2022
Date Signed: 11/22/2022 12:21:02 PM

Document Has Been Signed on 11/22/2022 12:21 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:SVS-SIMI VALLEYFACILITY NUMBER:
565801684
ADMINISTRATOR:LAURA WOODFACILITY TYPE:
775
ADDRESS:2381 TAPO STREET, UNIT DTELEPHONE:
(805) 582-1752
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 60CENSUS: 0DATE:
11/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Laura Wood, Administrator TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 11:30 a.m., the LPA was greeted and screened by staff. At 11:33 a.m., the LPA met with the Administrator and explained the reason for the visit. This annual had a specific emphasis on infection control practices and procedures. The day program currently does not have consumers inside the facility. The day program is operating its normal hours of 7:30 a.m. to 1:30 p.m. through remote learning and community outings.
At 11:45 a.m., the LPA, along with the Administrator toured the physical plant areas inside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations.

COMMON AREAS: The LPA observed the conference/rest area to be relatively clean and properly furnished. The LPA observed the fire extinguishers to be fully charged and last serviced on 12/08/2021. Cleaning solutions, toxins, chemicals and other hazardous items were inaccessible and locked away in the storage room. KITCHEN: The LPA observed the kitchen area. At 11:47 a.m., hot water measured at 112.8-degree Fahrenheit. CLASSROOM/OFFICES: LPA observed offices and the classroom/ activity rooms, which were observed to have the required furniture and supplies. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition. At 11:48 a.m., hot water measured at 116.8-degree F. Signs are posted throughout all four (4) bathrooms to promote handwashing. 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 temperature checks, and a sanitation station. LPA observed a 30-day supply of Personal Protection Equipment (PPE). The facility’s cleaning protocol is sufficient.

No deficiencies cited at this time. Exit interview was conducted. A copy of the report will be provided via email.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2022
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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