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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850343
Report Date: 08/09/2023
Date Signed: 08/09/2023 10:06:05 AM

Document Has Been Signed on 08/09/2023 10:06 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
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:TERNER HOME 2FACILITY NUMBER:
195850343
ADMINISTRATOR:BAGDASARIAN, SIRANUSHFACILITY TYPE:
740
ADDRESS:7056 MATILIJA AVENUETELEPHONE:
(818) 326-0336
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 6CENSUS: 0DATE:
08/09/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Siranush Bagdasarian, ApplicantTIME COMPLETED:
10:15 AM
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Licensing Program Analyst(LPA) Christine Yee conducted a subsequent Pre-licensing visit to the facility to ensure that the deficiencies noted on the initial Pre-licensing visit conducted on 7/26/23 were corrected . LPA Yee conducted the visit with the Applicant, Siranush Bagdasarian.
Per tour of the facility on today's visit, the following were observed::
  • the water temperature in the private bathroom located in bedroom #3 was tested at 9:21am and it read 116.8 degrees Fahrenheit.
  • Additional Linens, towels, comforters were purchased in quantities that allow for weekly changing or as needed.
  • dressers meeting Title 22 requirements were purchased for all the resident bedrooms
  • the fireplace in the living room was covered with a metal screen, which made it inaccessible to the residents
  • the slates in the vertical blinds were replaced in bedroom #3 and bedroom #4
  • the over head light fixtures in bedroom #4 were replaced
  • the twin bed located in the common area by the kitchen was removed and was replaced with a table and a bench
  • the snap locks on the cabinet used to store the cleaning supplies under the sink and the drawer containing the knives were replaced with a lock that requires the use of a key.
  • the unused ladders, fruit picker, chairs, cleaning buckets and mops stored along the right side of the house and in the back yard were stored away
  • Sufficient non-perishable foods were observed on today's visit. Applicant will purchase 2 days of perishable foods for 6 residents, that meet Title 22 requirements, prior to accepting the first resident.
  • Applicant will purchase the required liability insurance in the minimum amount required by Title 22.
As of today's visit, the physical plant has been cleared for licensure.

Exit interview was conducted.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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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