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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850337
Report Date: 09/29/2023
Date Signed: 09/29/2023 03:54:37 PM

Document Has Been Signed on 09/29/2023 03:54 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:COMFORT NESTFACILITY NUMBER:
195850337
ADMINISTRATOR:GHAZARYAN, ARAFACILITY TYPE:
740
ADDRESS:7061 TYRONE AVENUETELEPHONE:
(818) 334-9344
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 6CENSUS: 0DATE:
09/29/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ara Ghazaryan, ApplicantTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Christine Yee conducted an announced Prelicensing and Component III visit to ensure that the facility met Title 22 requirements. The visit was conducted with Ara Ghazaryan, Applicant. Also present during the visit was Ani Ghazaryan, sibling.

The facility is a single story family home consisting of a living room, dining room, kitchen, 3 bedrooms, 2 bathrooms and a attached garage. The facility is fire cleared for 5 AMBULATORY and 1 BEDRIDDEN. Bedroom #3 is the room designated for bedridden use. Per approved fire clearance, the garage may only be used as a garage.

The following were observed on today's visit:
  • the living is furnished with sectionals for more than 6 residents and a coffee table. Located in the living room is a fire place currently screened with a rope mesh. A fire screen is needed. An auditory device was observed on the front door and the sliding glass door in the living room.
  • the dining room is furnished with a table and six chairs and a desk
  • The kitchen is equipped with a refrigerator, dish washer, microwave and a stove. Forks, spoons, teaspoons, dinner plates, salad plates, bowls, cups and glasses for 12 persons were observed. Pots and pans were observed for cooking. Medications are stored in a locked kitchen cabinet and knives in a locked drawer.
  • Perishable foods for 2 days were not purchased and non-perishables foods did not meet the 7 day requirement and needs to be supplemented prior to accepting the first resident
  • A fire extinguisher purchased on 7/26/23 is located on the wall between the kitchen and dining room
  • Bedroom #1 has 2 hospital beds, 2 night stands, 2 chairs, 2 lamps, 2 built in closet. No dressers were observed. Located in the room is a full bathroom with a shower stall, a jacuzzi, a vanity with a sink.

continued on LIC809-C
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2023
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: COMFORT NEST
FACILITY NUMBER: 195850337
VISIT DATE: 09/29/2023
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  • Grab bars and a non-skid mat was observed. Water temperature was tested and it read 119.8 degrees.
  • Bedroom #2 has 2 hospital beds, 2 night stands, 2 chairs, 2 lamps, 1 built in closet. The 2 little dressers located in the room does not meet the 8 cubic feet requirement.
  • Bedroom #3 has 2 hospital beds, 2 chairs, 2 night stands, 2 lamps, 1 built in closet and 2 little dressers that do no meet the 8 cubic feet requirement. There is a sliding glass door that opens directly on to a ramp. The door is equipped with an auditory device that is operational.
  • all the beds in the resident rooms were observed with a plastic mattress cover, a fitted sheet, a flat sheet, a blanket but no bed covers. An extra set of linens, 2 bath towels, 2 hand towels and 2 face towels stored in the bedroom closet. Extra face towels, hand towels and bed covers were purchased during the visit.
  • all the windows and doors have blinds in good condition
  • the common bathroom has a shower stall, a vanity with a single sink and a toilet. Grab bars and a non-skid mat was observed. Water temperature was tested and it read 119.8 degrees Fahrenheit.
  • hygiene products/supplies such as toothpaste, shampoo, toothbrush, hair brush, nail file, cleaning solutions and disinfectants were observed in a locked hallway closet. Brooms, mops and buckets were also stored in the second hallway closet.
  • toilet paper and paper towels were observed in the laundry room closet
  • a carbon monoxide detector was observed in the hallway and was operational when tested
  • the hardwired smoke detectors located in the resident bedrooms and the hallway was tested and were operational.
  • night lights were observed in the hallway
  • a first aid kit with the required items and a first aid manual were observed.
  • the facility has a land line telephone. Telephone # is (818)849-5176
  • the backyard has 2 portable cabinets used for storage, a covered patio and was observed to be clean. However, the crates of tiles, toilet and mirror needs to be stored away. A table with chairs are needed for outside activities. Per Applicant, they were ordered but has not arrived.
  • the front yard was observed with rattan chairs and bistro tables and was clean.


continued on LIC809-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023
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: COMFORT NEST
FACILITY NUMBER: 195850337
VISIT DATE: 09/29/2023
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  • trash cans were observed to be tightly sealed
  • the garage is used for storage.
  • there were no bodies of water observed
  • there were no window bars observed

The following needs to be completed prior to licensure:
  • dressers that meet regulation requirements need to be provided in each bedroom
  • a fireplace screen needs to be placed in front of the fire place
  • remove/store the bathroom sink, toilet and mirror or have it picked up
  • applicant will purchase perishable foods for 2 days and supplement non-perishable foods to meet the 7 day requirement prior to accepting the first resident.
  • ensure that labor law poster for employees, Long Term Care Ombudsman contact information,visiting hours, a sign that states that a copy of the Admission Agreement will be available upon request are posted
  • ensure that liability insurance is purchased meeting Title 22 requirements - 1 million per incident for total aggregate of 3 million dollars, upon licensure.



Applicant will provide evidence of corrections once it has been completed.

Component III was also conducted with Ara Ghazaryan, Applicant.




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

DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3