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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850062
Report Date: 01/22/2024
Date Signed: 01/22/2024 12:34:54 PM

Document Has Been Signed on 01/22/2024 12:34 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:COLE VOCATIONAL SERVICES - SIMI VALLEYFACILITY NUMBER:
565850062
ADMINISTRATOR:CONK, SUSANFACILITY TYPE:
775
ADDRESS:660 EAST LOS ANGELES AVE UNT LTELEPHONE:
(805) 479-2604
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 45CENSUS: 28DATE:
01/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jesus CardenasTIME COMPLETED:
12:45 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 12/09/2022. Upon arrival, the LPA met with Program Manager, Jesus Cardenas and the reason for the visit was explained. Entrance interview conducted.

At 9:45 a.m., the LPA along with the Program 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 from 9:00 a.m. to 2:00 p.m. There are twenty-eight (28) individuals, and thirteen (13) program staff present today. The day program is currently staffed appropriately with the necessary staff to consumer ratios of 1:3. The facility has six (6) activity rooms, a conference room, several offices, and a food/service area.

Common Areas: At 9:50 a.m., the LPA observed the kitchen area. Kitchen appliances appeared clean and were in operable condition at the time of the visit. Knives and sharps were observed in a locked cabinet. There are two (2) fire extinguishers throughout the facility; they all were fully charged and were last serviced 11/15/2023. Carbon monoxide detectors are wired and operational at the time of the visit. The last fire inspection was completed on 06/08/2023 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 12/27/2023.

(Report Continued on LIC 809C...)

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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: COLE VOCATIONAL SERVICES - SIMI VALLEY
FACILITY NUMBER: 565850062
VISIT DATE: 01/22/2024
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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 individuals 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 five (5) restrooms for individual use. Restrooms were clean and sanitary. Restrooms were observed with a cabinet that included disinfecting wipes and disinfecting spray which were observed secured at the time of the visit. The LPA observed trash cans with lids to protect individuals from cross contamination. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature was measured in restrooms, and they measured at 109.7 degrees Fahrenheit at the time of the visit.



File Review: Records review began at 10:05 a.m.; four (4) individual 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.

Medications: Medications review began at approximately 11:35 a.m. Medications are centrally stored and locked inside a cabinet in the LVN’s office. All medications including PRNs were labeled, stored and locked inaccessible to individuals. 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.

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

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
LIC809 (FAS) - (06/04)
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