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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850295
Report Date: 01/23/2025
Date Signed: 01/23/2025 06:51:49 PM

Document Has Been Signed on 01/23/2025 06:51 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:CALA HOMESFACILITY NUMBER:
195850295
ADMINISTRATOR/
DIRECTOR:		JULIETTA MIRZOYANFACILITY TYPE:
740
ADDRESS:7331 LEMONA AVENUETELEPHONE:
(818) 849-6645
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 6CENSUS: 4DATE:
01/23/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:24 AM
MET WITH:Julietta Mirzoyan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
07:00 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 home by Avetis Keshishyan, Staff at 10:27am. Julietta Mirzoyan, Administrator was contacted by telephone and she arrived at 10:58am to conduct the visit. The reason for today's visit was provided.

The facility is a single storey family home consisting of a living room, dining room, a kitchen, four resident bedrooms, 2 full bathrooms and a detached garage. The facility is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN resident. Bedroom #4 is designated for 1 bedridden resident use. The facility is also approved for 5 hospice waivers.

On today's visit, all 12 domains of the Care Inspection Tool was reviewed. The following was observed for the physical plant:
  • The living room was furnished with the appropriate furniture and seating for 6 residents. The fire place was sealed off with a cover. Above the fire place was a mounted television. The outside exiting door is equipped with a auditory device and leads out to a ramp.
  • The front door is equipped with an auditory device that was operational.
  • The dining room was furnished with a table and 6 chairs,
  • The kitchen was observed with a stove with an oven, microwave, toaster oven, toaster and a refrigerator. A cabinet containing resident and staff files was observed. Cleaning solutions and dish soaps were stored in a locked cabinet under the sink. Knives were stored in a locked drawer. The only fire extinguisher purchased on 11/30/24 was observed in the kitchen.
  • Bedroom #1 was furnished with 2 hospital beds, 2 night stands, 2 chairs, 2 lamps, a shared dresser and a built in closet. Window dressings was observed. The beds were not made up as it was vacant.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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: CALA HOMES
FACILITY NUMBER: 195850295
VISIT DATE: 01/23/2025
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  • The common bathroom was equipped with a shower, a single sink and a toilet. Grab bars and a slip resistant mat and shower chair was observed. Located inside is a locked linen closet with extra blankets, bed linens, bath towels and blankets were observed. Also located in the closet are the hygiene products.
  • Bedroom #2 was observed with a hospital bed with half a bed rail, a night stand, a lamp, a chair, a dresser and a built in closet was observed. Bed linens and blankets per the resident's personal preference was observed. Also observed in the room was an oxygen tank and a oxygen concentrator. Oxygen in use sign was observed on the room door and front door.
  • The required posters were observed by the front door and the labor poster in the kitchen.
  • Bedroom #3 was observed with a hospital bed, a night stand, a lamp, a dresser and a built in closet. The outside exiting door was equipped with a auditory device and leads out to a ramp.
  • Bedroom #4 was observed with 2 hospital beds, 2 night stands, 2 lamps, 2 chairs, a shared dresser, 2 portable closets, and a fire place that has been sealed off. The outside exiting door was equipped with an auditory device and leads out to a ramp.
  • The first aid kit with the required dressings, bandages, tweezer, scissors and thermometer were observed. A first aid manual was also observed.
  • The facility has current liability insurance that meets Title 22 requirements - 1 million per occurrence for a total annual aggregate of 3 million dollars.
  • The facility is completely enclosed on the outside and has a covered patio. A table and 6 chairs were observed for outside activities.
  • The trash cans were observed to be in good condition and were tightly sealed.
  • Overall, the backyard and the front yard was well maintained.


No deficiencies were cited on today's visit.

Exit interview was conducted and a copy of the report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC809 (FAS) - (06/04)
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