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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802408
Report Date: 07/07/2022
Date Signed: 07/07/2022 04:02:56 PM


Document Has Been Signed on 07/07/2022 04:02 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:REGAL CAREFACILITY NUMBER:
565802408
ADMINISTRATOR:BRODT, DONALDFACILITY TYPE:
740
ADDRESS:3316 GREENVILLE AVENUETELEPHONE:
(805) 587-2992
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:6CENSUS: 5DATE:
07/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:39 PM
MET WITH:Zuleima GonzalezTIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPA) Zabel Chochian conducted an unannounced Required Annual inspection.
This annual had a specific emphasis on infection control practices and procedures. The LPA met with staff and reason for visit was explained. Staff contacted Administrator and reason for visit was explained. Administrator stated that his designated staff will assist LPA with today's visit. Staff and LPA toured the physical plant areas to ensure the facility is in compliance with the Infection control requirements.

INFECTION CONTROL: During today’s visit, LPA spoke with the Administrator and staff regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. 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 has not had a confirmed case of COVID-19 at this time; however, the facility’s policies and procedures as it pertains to infection control appeared to be in compliance during todays visit.

Following Technical Advisory note issued: Licensee/Administrator was informed that the following signs should be posted: 1) Updates to visitor policy to notify of policies and procedures necessary to protect residents from infection during pandemic, in accordance with personal rights requirements.
2)Signs are posted throughout facility to promote hand washing, cough/sneeze etiquette, and physical distancing. 3) Signs are posted throughout facility to encourage residents to report acute respiratory illness to staff.

Facility observed in substantial compliance with infection control practices during today's visit.
Exit interview conducted with staff. Copy of report email to Licensee/Administrator.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel ChochianTELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022
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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