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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850248
Report Date: 04/29/2022
Date Signed: 04/29/2022 10:58:51 AM

Document Has Been Signed on 04/29/2022 10:58 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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:TERNER HOME 1FACILITY NUMBER:
195850248
ADMINISTRATOR:BAGDASARIAN, SIRANUSHFACILITY TYPE:
740
ADDRESS:13921 CANTLAY ST.TELEPHONE:
(818) 326-0336
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 6CENSUS: 5DATE:
04/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Siranush Bagdasarian and Kevin PoghosyanTIME COMPLETED:
10:45 AM
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Licensing Program Analysts (LPA) Ashley Smith conducted an unannounced case management visit at the location today at 9:30 a.m. The purpose of this visit was to conduct a follow up inspection of the property to check on the health and safety of residents in this location. The LPA was greeted by applicant Siranush Bagdasarian and informed them of the reason for the visit.

On 02/09/2022, the Department substantiated an allegation of "Unlicensed Care", as it was determined that the Operator retained a tenant (T1) that required care and supervision. Aspects of care were provided which included centrally storing medication, assistance with medication management, bathing, and transferring. An application was submitted via mail with the Department of Social Services for the Licensure of this property on 02/23/2022 under Terner Home 1 (195850248). As of today, the application is still in process.

Today, the LPA conducted a physical plant tour and met with applicant Ms. Bagdasarian and Operator Kevin Poghosyan. At the time of the visit, there were five tenants. However, the LPA discovered that out of the five tenants that were identified during the initial visit conducted on 02/09/2022, two out the five tenants moved out (T1, T2). At this time, there were two new tenants identified (T6, T7). The LPA interviewed the two tenants at 9:38 a.m. and 9:45 a.m. At the time of the interview, the LPA did not determine that the staff were providing aspects of care to T6 and T7. The LPA reiterated that during this process, the Operator nor the applicant can accept new tenants at this location, even if tenants move out.

At 9:55 a.m., a fire inspector from the LA Fire Department arrived to complete the facility’s fire inspection per the pending application. Per the fire inspector, they will revisit the location pending required corrections.

No immediate health and safety concerns were noted during this visit. No deficiencies cited at this time. Report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2022
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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