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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850295
Report Date: 12/13/2022
Date Signed: 12/13/2022 04:14:54 PM

Document Has Been Signed on 12/13/2022 04:14 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:CALA HOMESFACILITY NUMBER:
195850295
ADMINISTRATOR:GHAZARYAN, NARINEFACILITY TYPE:
740
ADDRESS:7331 LEMONA AVENUETELEPHONE:
(818) 636-1064
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 6CENSUS: 0DATE:
12/13/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Julietta Mirzoyan TIME COMPLETED:
11:00 AM
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On 12/13/2022, Licensing Program Analyst (LPA), Sandra Urena, conducted a subsequent pre-licensing visit at 10:15 a.m. to confirm that the deficiencies found on 12/01/2022 were resolved. The LPA met with the applicant Julietta Mirzoyan. The applicant, and the LPA toured the facility, and found all deficiencies corrected during today's visit.

On 12/01/2022, the pre-licensing visit was conducted by Licensing Program Analyst (LPA), Sandra Urena. The LPA arrived at the facility at 10:30 a.m., and met with applicant Julietta Mirzoyan. This is a new facility application for a total of six residents, five non-ambulatory, and one bedridden. Fire Clearance was approved on 08/12/2022 for one bedridden resident, and resident is allowed to reside in bedroom # 3. The applicant was to notify the Fire Department and CAB in the event that they wanted to change to room number for the bedridden resident.


Continues on LIC 809C...
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2022
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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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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CALA HOMES
FACILITY NUMBER: 195850295
VISIT DATE: 12/13/2022
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The following deficiencies were corrected:

1. Water temperature was recorded at 109.2 Fahrenheit in the kitchen.
2. Water temperature was recorded at 109.5 Fahrenheit in bathrooms #1 and #2.
3. Signal systems for bedrooms # 1, 2, and 4 were installed.
4. Applicant Contacted Centralized Application Bureau (CAB) and Fire Department for changes in the location(bedroom) of the bedridden resident. CAB notified the WHN office that CAB was able to obtain an updated STD 850 from the Fire Department. Bedroom #4 has been designated for the bedridden resident.
5. Paper towels were added to bathroom #2.
6. Applicant obtained sufficient supply of linens to permit changing weekly or more often as needed to ensure use of linens at all times.
7. Passageway for residents, and non-ambulatory residents to access the outdoor area will be through bedroom # 3.

This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.

Exit interview was conducted and reviewed with applicant Julietta Mirzoyan. A copy of the report was provided

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
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