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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610004
Report Date: 11/04/2021
Date Signed: 11/04/2021 04:54:16 PM

Document Has Been Signed on 11/04/2021 04:54 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:VALLEY VIEW ASSISTED LIVINGFACILITY NUMBER:
197610004
ADMINISTRATOR:GASPARYAN, SUSANNAFACILITY TYPE:
740
ADDRESS:20565 CALIFA STREETTELEPHONE:
(747) 226-1408
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 6CENSUS: 3DATE:
11/04/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 AM
MET WITH:Susanna GasparyanTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Ashley Smith arrived at 1:45 p.m. to meet with Administrator Susanna Gasparyan for a technical support visit with this facility. In attendance included Public Health Nurses Brenna De Leon, Amber Fayton, and Dr. Camellia Babaie, from Los Angeles County Public Health. This visit had a specific emphasis on infection control practices.

This facility has a central entry point for signing in, symptom screening, and temperature checks. The facility has appropriate signs to promote mask-wearing and regular usage of hand sanitizer; recommendations were made around signage placement to further promote physical distancing, proper hand hygiene, and how to appropriately utilize Personal Protection Equipment (PPE). Additional feedback was provided regarding isolation and quarantine requirements, disinfection practices, and documentation of vital signs for staff and residents.

During today's visit, discussion was had regarding testing, symptom screening, and adjusted procedures around visitation. The cleaning and disinfectant protocol is adequate; however, staff were reminded to observe the contact time needed for surfaces to be properly disinfected. It was recommended to provide additional staff training pertaining to donning, doffing, and appropriate disinfecting of reusable Personal Protection Equipment. Further discussion was had with the Administrator around the recent Provider Information Notice (PIN) as it relates to visitation and staff vaccination requirements.

No health and safety hazards noted during today's visit. Exit interview conducted. A copy of the report was provided via email for signature.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2021
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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