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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850337
Report Date: 11/19/2024
Date Signed: 11/19/2024 02:57:28 PM

Document Has Been Signed on 11/19/2024 02:57 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/
DIRECTOR:		GHAZARYAN, ARAFACILITY TYPE:
740
ADDRESS:7061 TYRONE AVENUETELEPHONE:
(818) 334-9344
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 6CENSUS: 5DATE:
11/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:51 AM
MET WITH:Administrator, Ara Ghazaryan TIME VISIT/
INSPECTION COMPLETED:
03:05 PM
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(PAGE 1)
Licensing Program Analyst (LPA) Erica Mosley arrived at the facility at approx. 9:50a.m. to conduct an unannounced required annual visit. Upon arrival, LPA Mosley was greeted by staff and called the Administrator to inform them of the visit. The Administrator arrived shortly thereafter. The LPA met with Administrator Ara Ghazaryan and explained the reason for the visit. The 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.

The facility is a single-story family home consisting of a living room, dining room, kitchen, 3 bedrooms, 2 bathrooms and an 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.

BEDROOMS: There are three (3) double occupancy / shared bedrooms. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Inside temperature was maintained at a comfortable level.

RESTROOMS: The facility has two (2) resident restrooms, one (1) is designated as a shared restroom, and one (1) is designated as a private restroom. Restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. From approx. 10:23 a.m.- 10:32 a.m., hot water was measured in both restrooms at 117.3 F and 120.0-degree Fahrenheit. Both restrooms within the required range. The sinks had sufficient liquid soap, and paper towels.
Continued on LIC 809-C 2nd page
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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: COMFORT NEST
FACILITY NUMBER: 195850337
VISIT DATE: 11/19/2024
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(PAGE 2) Report Continued from LIC 809 PAGE 1....
KITCHEN: At approx. 10:30 a.m. the LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. At 10:35 a.m. the hot water measured at 118.6-degree Fahrenheit. Within the required range. Medications are stored in a locked cabinet. Cleaning solutions, toxins, chemicals, and hazardous items were inaccessible and locked away in a cabinet under the sink area.

COMMON AREAS: The LPA observed the common areas to be clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and purchased on 04/20/2024. At 12:09 p.m., fire alarms/ carbon monoxide detectors were tested and functioned properly at the time. Laundry units are located in the hallway. Extra cleaning solutions, toxins, chemicals, and hazardous items were inaccessible and locked away in a locked hallway closet. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 07/24/2024 and 07/25/2024 to accommodate all shifts and are conducted quarterly. Activities were observed in the common areas. There is a fireplace in the living room that was adequately screened.

OUTDOOR SPACE / GARAGE: The garage is maintained locked at all times. LPA observed an adequate amount of emergency food and water. Cleaning supplies are kept in the garage locked and inaccessible to residents in care. The facility has two (2) extra refrigerators in the garage with extra food for daily use. LPA observed the back patio which has a covered patio area with furniture including a table and chairs for resident use. All passageways were observed to be clear. There are two (2) small storage units supplying extra supplies. There were no bodies of water noted at the time of the visit.

RECORDS: Resident Records were reviewed beginning at 10:41 a.m. and personnel records at 11:20 a.m. Five (5) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. Five (5) personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order.

Continued on LIC 809-C 3RD PAGE

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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: COMFORT NEST
FACILITY NUMBER: 195850337
VISIT DATE: 11/19/2024
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(PAGE 3) Report Continued from LIC 809C PAGE 2....
INTERVIEWS: Two (2) staff interviews were conducted. Two (2) resident interviews were conducted during the inspection.

MEDICATIONS: Medications review began at approximately 12:15 pm. The medications are locked in a cabinet in the kitchen. Medications for five (5) residents were reviewed. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records.

Documents obtained during inspection: LIC 500 Staff Roster, LIC 9020 Resident Roster, and Current liability insurance.

No deficiencies were cited during today’s inspection. Exit interview conducted. A copy of the report was provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC809 (FAS) - (06/04)
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