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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609643
Report Date: 04/14/2022
Date Signed: 04/14/2022 11:25:40 AM

Document Has Been Signed on 04/14/2022 11:25 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:
04/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Anna Hakobyan TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Brian Balisi arrived to this facility today to conduct a One (1) year Required inspection of this facility with emphasis on infection control practices and procedures. LPA met Administrator Anna Hakobyan and explained the reason for the visit. There are (4) clients in care at this time.

The kitchen appeared to be clean at this time and the appliances and fixtures functional during the time of visit. LPs observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects were observed stored in a locked drawer to the right of the sink. No Cleaning supplies and toxins were observed in this area at this time. To the right of the kitchen was the office area as well as the laundry area. No detergents or cleaning supplies were observed stored in this area. There is an attached garage that was observed inaccessible to residents at this time. LPA observed emergency food supply, medical supplies, cleaning supplies and extra furniture at this time.

Dining furniture in dining room area appeared to be clean and sufficient at this time. At approx 10am, LPA observed staff preparing food in the kitchen.

The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. There is entry closest that stored PPE, medication, and facility files. LPA observed closet locked at this time.

LPA observed bathrooms were clean, properly supplied and had functional fixtures at this time. The hot water was measured in between 105 - 120 degrees Fahrenheit.

Continued on 809-C
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: VALERIO CASTLE INC
FACILITY NUMBER: 197609643
VISIT DATE: 04/14/2022
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Continued from 809-C

Living room was checked cleanliness and furniture was checked for functionality during time of visit. Living room furniture appeared to be relatively clean and functional at this time. LPA observed first aid kit properly supplied including a first aid manual in the kitchen.

There was a shaded area with sufficient room for activities. LPA observed sufficient furniture designated for outdoor use. There are no bodies of water on the premises. LPA did not observe any obstructions to exits at this time.

The LPA spoke with Anna regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate supply of Personal Protection 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 bedroom as a single isolation room if the facility has a confirmed case of COVID-19. COVID-19 testing is conducted weekly if anyone shows any symptoms. The facility’s policies and procedures as it pertains to infection control are adequate at this time.

Exit interview conducted. Report issued and sent via email.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
LIC809 (FAS) - (06/04)
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