197609056-5-11-2023-29-AS-BBAI-CRQV58-20230511160731

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609056
Report Date: 05/11/2023
Date Signed: 05/11/2023 04:08:42 PM

Document Has Been Signed on 05/11/2023 04:08 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:	EASTER SEALS SOUTHERN CALIFORNIA VAN NUYS		FACILITY NUMBER:	197609056
ADMINISTRATOR:	FERNANDEZ, CYNTHIA		FACILITY TYPE:	775
ADDRESS:	16605 SHERMAN WAY		TELEPHONE:	(818) 388-7428
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91406
CAPACITY: 50		CENSUS: 30	DATE:	05/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Michael Smith - Program Director		TIME COMPLETED:	04:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced required annual. Upon arrival LPA met with Program Director Michael Smith and explained the reason for the visit. LPA and Smith toured the physical plant areas inside and outside at approximately 1pm to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. There were (30) clients inside the facility participating for services. Kitchen appliances appeared to be in operable condition at this time. The facility has a sufficient supply of non-perishable food properly stored. All knives and cleaning supplies were observed to be inaccessible inside a lock box in storage room by entry way. LPA observed the storage room to be inaccessible to clients and to also store PPE, cleaning supplies, emergency supplies, and other facility supplies at this time. Public restrooms were observed to be clean and sanitary and in operating condition. LPA observed a sufficient amount of soap and paper products in each restroom, as well as hand washing posters. Hot water measured between 110 - 112 degrees Fahrenheit during the time of the inspections. In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and office furniture were observed to be in good condition. During the physical plant clients were observed participating in activities throughout the facility. LPA observed the required postings throughout the facility. Fire extinguishers were observed to be fully charged and last serviced in June of 2022. Carbon / Fire detectors were also observed to be working at the time of visit. LPA observed a large open area in which program activities are provided, as well as multiple multi-function rooms and offices. Furniture's were observed in good repair. Other equipment used for activities appears to be in adequate condition. LPA did not observe any obstructions or hazards during the visit.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023

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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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: EASTER SEALS SOUTHERN CALIFORNIA VAN NUYS	FACILITY NUMBER: 197609056
	VISIT DATE: 05/11/2023

NARRATIVE

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There is a shaded patio area in the rear of the facility next to the parking lot. LPA observed outdoor furniture appropriate for outdoor use. There is a gate that surrounds the exterior of the building and parking lot. LPA observed gate to be open at this time There is a storage shed in the rear of the facility. LPA observed shed to store extra supplies for facility use at this time. . LPA did not observe any obstructions to exits at this time.

INFECTION CONTROL: During today’s visit, the LPA spoke with Smith regarding the facility’s infection control practices. Upon entry, the facility has a single entry point for symptom screening. The LPA observed an adequate supply of Personal Protective 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’s policies and procedures as it pertains to infection control are adequate at this time.

At approximately 2pm, records review began. (6) client records were reviewed and (6) personnel records were reviewed. All records were observed to be in order at this time.

At approximately 3pm LPA interviewed (5) staff.

At approximately 3:30pm, LPA interviewed (2) clients. The majority of the clients were preparing to depart the facility for the day.

Exit interview conducted and a copy of the report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023

LIC809 (FAS) - (06/04)

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