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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209266
Report Date: 10/21/2022
Date Signed: 10/21/2022 12:47:47 PM

Document Has Been Signed on 10/21/2022 12:47 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:HEAVENLY CASTLE CARE INCFACILITY NUMBER:
157209266
ADMINISTRATOR:NSHANYAN, HASMIKFACILITY TYPE:
740
ADDRESS:1651 WHITE ROCK RDTELEPHONE:
(310) 993-2447
CITY:FRAZIER PARKSTATE: CAZIP CODE:
93225
CAPACITY: 6CENSUS: 0DATE:
10/21/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:33 AM
MET WITH:Hasmik NshanyanTIME COMPLETED:
01:19 PM
NARRATIVE
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A Prelicensing visit was conducted on the date & during the times indicated above by Licensing Program Analyst (LPA) L. Xiong. LPA met with Administrator, Hasmik Nshanyan. Physical plant toured. This facility has no pool, spa, hot tub, fountains, etc.
Activity, community, & dining rooms sufficiently furnished with adequate lighting. Kitchen toured. Two (2) day supply of perishable & 7 day supply of non-perishable food on the premises. Resident rooms toured. Rooms sufficiently furnished with adequate lighting. Resident bathrooms toured. Grab bars in toilet & shower areas. Non-skid mats in observed in showers. Hot water measured at 118 degrees. Interior & exterior passageway observed to be free of obstructions. Facility has a locked medication room. Outside area toured. No hazards observed.

No outstanding issues. Component III conducted during this visit.
Exit interview conducted with Administrator.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2022
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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