197610073-10-20-2021-31-AS-APAA-C7YP2B-20211020105541

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610073
Report Date: 10/20/2021
Date Signed: 10/20/2021 10:57:01 AM

Document Has Been Signed on 10/20/2021 10:57 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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	CANYON VIEW RESIDENTIAL CARE FACILITY INC 2		FACILITY NUMBER:	197610073
ADMINISTRATOR:	VENTURA, CHERYL M		FACILITY TYPE:	740
ADDRESS:	23505 VIA CASTANET		TELEPHONE:	(562) 881-4998
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91355
CAPACITY: 6		CENSUS: 6	DATE:	10/20/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:57 AM
MET WITH:	Cheryl Ventura, Administrator		TIME COMPLETED:	11:20 AM

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At 9:25am Licensing Program Analyst (LPA) Angela Panushkina, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the Administrator, Cheryl Ventura, who granted access to the facility. At approximately, 09:30am physical tour was conducted with the Administrator and LPA observed the following:

Infection control: LPA reviewed the facility mitigation plan (approved on 04/08/2021) to make sure licensee was following current infection control recommendations. Upon arrival, LPA was screened and asked to sign-in the visitors’ log. In addition, LPA was asked all infection control questions. Proper signage was observed inside along the hallway and in the restrooms. Hand sanitizer was also observed. Administrator stated they have sufficient PPE supplies for residents and staff. LPA observed all trash can throughout the facility have fitted lids.

Kitchen: At approximately, 9:30am LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharp objects were locked and inaccessible to residents in care.

Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 9:55am they were tested and observed to be operational.

Bedrooms: There are five (5) out of six (6) bedrooms designated for resident’s use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. All exit doors had auditory alarms in a condition and observed to be operational. The facility has two (2) Dementia residents in care.

Bathrooms: At 09:52am, LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 113.7°F.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021

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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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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CANYON VIEW RESIDENTIAL CARE FACILITY INC 2	FACILITY NUMBER: 197610073
	VISIT DATE: 10/20/2021

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LPA observed appropriate grab bars and had non-skid mats as well as hand washing signs posted in each bathroom.

Common Areas: The facility maintains a comfortable temperature at 74°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. There is a fire extinguisher in the kitchen area and was last serviced on 03/12/21.

Outside areas: At approximately, 10:00am LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. There are no bodies of water. There was a detached, covered patio/room built in a backyard, from a previous owner, and that room was designated for staff use only.

The garage: Laundry area is located in an attached garage and kept locked and inaccessible to residents in care. Extra PPE supplies and food storage was also observed.

Medications: At approximately, 9:35am LPA observed medications are centrally stored and locked in the cabinet, by the kitchen area and inaccessible to residents in care.

Administrative: LPA collected Certificate of Liability Insurance, and LIC.500. Annual fees are current

Exit interview conducted and copy of this reported was provided to the Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021

LIC809 (FAS) - (06/04)

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