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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802464
Report Date: 02/28/2023
Date Signed: 03/13/2023 11:19:48 AM


Document Has Been Signed on 03/13/2023 11:19 AM - 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:EMBRACING SENIORSFACILITY NUMBER:
565802464
ADMINISTRATOR:TRUPIANO, JOSEPHFACILITY TYPE:
740
ADDRESS:729 MUIRFIELD AVETELEPHONE:
(805) 422-8441
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:6CENSUS: 6DATE:
02/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Regie Dulay, StaffTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Zabel Chochian conduct a required annual visit to this facility today.

The LPA met with staff and reason for visit was explained. Staff contacted Licensee/Administrator Joseph Trupiano. LPA spoke with Mr. Trupiano who stated that he is unable to meet with LPA today. Mr. Trupiano stated that his staff will be able to assist LPA with the visit. LPA spoke with Mr. Trupiano regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening and sanitation station. Infection control postings were observed. No hand washing signs observed in the restrooms. Staff will ensure the hand washing signs are posted back in the restrooms. The facility had an adequate supply of Personal Protection Equipment (PPE). Infection Control and Mitigation Plan received - the facility has appropriate plans in place in the event of residents and/or staff showing symptoms of COVID or testing positive for COVID. The LPA and staff toured the physical plant areas inside and outside at approximately 2:15pm to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The carbon monoxide and smoke alarms were tested and all functioned properly. The fire extinguisher was last serviced 09/2022. KITCHEN: Knives observed in locked drawer and cleaning supplies in a locked cabinet under the sink. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All medications were stored in locked cabinets. BEDROOMS: The LPA observed two single-occupancy resident bedrooms and two shared bedrooms which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: Restrooms are clean and sanitary and in operating condition. The hand washing sign was missing from both restrooms. Staff reported that they removed the signs. Staff agreed to posted the hand washing signs back up in the restrooms. COMMON SPACES: The living room, family room and dining room furniture were observed to be in good condition. Backyard patio observed clean with no hazards; patio area is equipped with furniture for resident use.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel ChochianTELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023
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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