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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609643
Report Date: 05/14/2021
Date Signed: 05/14/2021 11:18:58 AM

Document Has Been Signed on 05/14/2021 11:18 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:VALERIO CASTLE INCFACILITY NUMBER:
197609643
ADMINISTRATOR:HAKOBYAN, ANNAFACILITY TYPE:
740
ADDRESS:15360 VALERIO STTELEPHONE:
(310) 435-1445
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 4CENSUS: 4DATE:
05/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Anna Hokobyan - Administrator TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced Required Annual inspection. LPAs met with Administrator Anna Hakobyan and explained the reason for the visit.

Between 10:00am - 11:30am, LPA conducted physical plant with Anna. LPAs also conducted interviews with residents and some staff.

Between 10:00am - 11:30am, LPA did not observe a sufficient amount of the following: Signs that are posted throughout facility to promote hand washing , cough / sneeze etiquette, and physical distancing and signs that are posted throughout facility to encourage residents to report acute respiratory illness to staff.

Anna also informed LPAs that not all staff have been fit tested for N95 respirators.

LPA advised Anna to post additional signs throughout the facility and LPA will provide Anna with information and resources to have all staff fit tested for N95 respirators.

Exit interview conducted with Anna Hokobyan, report issued and sent via E-mail.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2021
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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