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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850145
Report Date: 12/16/2024
Date Signed: 12/16/2024 11:28:05 AM

Document Has Been Signed on 12/16/2024 11:28 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:PALS WTC SIMI VALLEYFACILITY NUMBER:
565850145
ADMINISTRATOR/
DIRECTOR:
ASH GALARDIFACILITY TYPE:
775
ADDRESS:1494 MADERA ROAD, SUITE A1TELEPHONE:
(805) 842-9505
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 45CENSUS: 36DATE:
12/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:49 AM
MET WITH:Ash GalardiTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. The LPA met with Admistrator Ash Galardi. Reason for the visit was stated.

The program currently operates from 8:00AM to 2:00PM. The day program was staffed with 1:3 and 1:1 staff to participant ratios. Temperatures of staff and participants are taken upon entry into the facility.

Beginning at 10:00AM, LPA along with Administrator, toured the physical plant area to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The following was observed:

Common Activity Space: The facility is a single-story structure with a large activity room, small conference rooms, two (2) bathrooms, offices, and a food service area. LPA did not observe any obstructions or hazards. Furniture and equipment was observed to be in good condition. Smoke detectors and carbon monoxide detectors were in operable condition.

Food Service: The kitchen area was clean and in good condition. Consumers bring their lunch and snacks. Consumers also go out to eat.

Restrooms: Restrooms observed to be clean and sanitary and stocked with soap, paper towels and toilet paper. Water temperature was measured in bathrooms and kitchen sink and was within the required range.

During today's annual, LPA Dulek visited and toured the day program today to determine if it is feasible to convert the day program into an emergency shelter when a natural disaster happens in the area. Further discussion will occur between the Regional Centers and the Department of Developmental Services. Licensee will be notified once a decision is made.

No deficiencies cited. Exit interview conducted. A copy of the report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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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