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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850176
Report Date: 08/21/2024
Date Signed: 08/21/2024 06:07:19 PM

Document Has Been Signed on 08/21/2024 06:07 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:NOHO ASSISTED LIVING, INCFACILITY NUMBER:
195850176
ADMINISTRATOR/
DIRECTOR:		ARPINE MKRTCHYANFACILITY TYPE:
740
ADDRESS:6331 SIMPSON AVETELEPHONE:
(818) 404-0550
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 6CENSUS: 4DATE:
08/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:01 AM
MET WITH:Arpine Mkrtchyan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
06:15 PM
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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool. LPA Yee was let into the facility by Anahit Anatomyan, Staff. Arpine Mkrtchyan, Administrator, was contacted via telephone and she arrived at 11:25am to conduct the visit. The reason for the visit was provided.

The facility is a single storey family home consisting of a living room, dining room, a kitchen, 3 resident bedrooms, 2.5 bathrooms, a den, a laundry room and a attached garage. The facility is fire cleared for 6 non-ambulatory residents.

On today's visit, all 12 domains, 4 resident and 5 staff files were reviewed. All 4 residents are receiving hospice services.

The following were observed on today's visit:
  • The dining room and living room have the appropriate furniture for 6 residents and was clean
  • The fire place located in the living room was observed with a metal fire screen.
  • The kitchen has the standard equipment - stove, refrigerator, toaster oven, coffee maker and dishwasher and was observed to be operational and clean. Knives are stored in a locked drawer.
  • sufficient perishable and non-perishable foods were observed in the kitchen and in the garage
  • Bedroom #1 and Bedroom #2 contained 2 hospital beds with full bed rails, 2 chairs,2 night stands, 2 lamps, a shared dresser, a shared closet and blinds for privacy. Located inside bedroom #1 is a private bathroom equipped with a shower stall, a toilet and a sink. Grab bars, a non-skid mat and a shower chair was observed. Water temperature was tested and read 116 degrees Fahrenheit. No window bars were observed in either bedroom.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/21/2024
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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: NOHO ASSISTED LIVING, INC
FACILITY NUMBER: 195850176
VISIT DATE: 08/21/2024
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  • Bedroom #3 was observed with 2 hospital beds, 2 lamps, 2 night stands, 2 chairs and 1 shared dresser. The hospital bed to the back of the room was equipped with a full bed rail.
  • The linen closet closet located by bedroom #1 was observed with extra linens, blankets and towels
  • The half bathroom is equipped with a toilet and sink. Water temperature was tested and it read 116.2 degrees Fahrenheit.
  • The common bathroom located closest to bedroom #3 was observed with a tub and shower, a toilet and a single sink. Grab bars and non-skid mat was observed. The water temperature was tested and it read 116.7 degrees Fahrenheit.
  • Located by the common bathroom is the laundry room with a washer and dryer. Hygiene products and cleaning supplies were observed in the cupboards. Laundry room is locked.
  • Located between bedroom #2 and #3 is the family room equipped with 2 sofas and a mounted television set.
  • The only fire extinguisher purchased on 6/16/24 is located on the wall between the kitchen and dining room.
  • The auditory devices mounted on the front door and the back door were operational.
  • The first aid kit was reviewed and contained the required tweezer, scissors and thermometer. First aid manual was observed.
  • The hardwired combination smoke/carbon monoxide detectors were tested and were operational.
  • The backyard was observed with an umbrella and seating for outside activity. The backyard and the sides of the home were observed to be clean.
  • The front yard was observed with a table and 2 chairs. The front yard was also observed to be clean.
  • Trash cans located in the front were well maintained and were observed to be tightly sealed.
  • The attached garage is used primarily for storage of extra beds, furniture and food supply.


No deficiencies were cited on today's visit.

Exit interview was conducted.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
LIC809 (FAS) - (06/04)
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