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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850206
Report Date: 04/18/2024
Date Signed: 04/18/2024 04:53:47 PM

Document Has Been Signed on 04/18/2024 04:53 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:A'VILLAFACILITY NUMBER:
195850206
ADMINISTRATOR/
DIRECTOR:		HAKOBYAN, ANNAFACILITY TYPE:
740
ADDRESS:6532 GLORIA AVE.TELEPHONE:
(310) 435-1445
CITY:LAKE BALBOASTATE: CAZIP CODE:
91406
CAPACITY: 6CENSUS: 4DATE:
04/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Anna HakobyanTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Valeria Conway arrived at the facility at 11:52 a.m. to conduct an unannounced required annual. Upon arrival LPA met with Administrator Anna Hakobyan and explained the reason for the visit.

There are three (3) residents at the time of the visit. The facility serves level 3 clients from North Los Angeles County Regional Center.

At approximately 12:00 p.m., back up administrator Armine Melkonyan arrived at the facility. At 12:15 p.m. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. During physical plant tour LPA observed the required postings throughout the facility. Complete First aid kits were observed throughout the house with correspondent manual.

Facility is a single-story residence and consists of a total of five (5) bedrooms and two (2) bathrooms designated for clients use. One (1) bedroom, room #4 is designated for staff use only. At 2:17 p.m. the carbon monoxide and smoke alarms were tested and all functioned properly. The fire extinguisher was fully charged and last purchased on January 8th, 2024. Last emergency drill (Fire) was conducted on 01/02/2024. Centrally stored medication and records reviewed at approximately 2:45 p.m. At 1:27 p.m. Staff and client files were reviewed. Required training and staff records observed on file for current employees. Required client records observed on file and up to date at the time of the visit.

Continued on LIC 809-C
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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 3
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: A'VILLA
FACILITY NUMBER: 195850206
VISIT DATE: 04/18/2024
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Continued from LIC 809

Kitchen: LPA observed kitchen to be clean at this time and the appliances were clean and all and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects were observed stored in 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 laundry area. Cleaning supplies were observed to be stored and locked in cabinets above the washer and dryer and in a cabinet under the sink located in this area as well. The supply of dishes, utensils, pots, pans and drinkware is adequate. There are no pesticides (poisons), or toxins stored in any food storage area or preparation area with utensils.

Bedrooms: The resident bedrooms were properly furnished with a bed, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a sufficient supply of linen and personal hygiene supplies in the hallway closet right outside of bedroom #1 The resident bathroom(s) has a shower with non-skid materials. The toilet and showers have grab bars. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F.

Common Areas: These included the living room, dining area and office area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Dining room furniture appeared to be relatively clean and functional at this time. Medications, first aid and facility files are to be stored in locked cabinet outside of bedroom #1. LPA observed a locked cabinet that stored a sufficient amount of PPE, linen and extra medical supplies outside of bedroom #2. Night lights were maintained in hallways and passageways to nonprivate bathrooms. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. Alarms on all exterior doors were engaged at the time of visit and functional.

Continued on LIC 809-C
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: A'VILLA
FACILITY NUMBER: 195850206
VISIT DATE: 04/18/2024
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Continued from LIC 809-C

Outdoor Area: There was a shaded area with sufficient room for activities. LPA observed sufficient furniture designated for outdoor use. There is a gated swimming pool located in the backyard. Garage was accessible from the exterior of the building. Licensee opened garage from inside the house and LPA observed gardening material, extra medical supplies, a freezer with extra food and decorations for facility use. The exterior passageways were clean and clear of any obstructions. The entire property is fenced with a gated driveway. There is a door w/gate with a self-latching mechanism for persons to easily exit the property in the event of an emergency. Administrator resides in the home behind the facility that is located on the same property; however, the administrator’s personal home has a different address.

Exit interview conducted and report issued to the Administrator.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC809 (FAS) - (06/04)
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