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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850419
Report Date: 09/20/2024
Date Signed: 09/22/2024 05:43:39 PM

Document Has Been Signed on 09/22/2024 05:43 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:LOVING HOME INCFACILITY NUMBER:
195850419
ADMINISTRATOR/
DIRECTOR:		EDITH MARDOROSSIANSFACILITY TYPE:
740
ADDRESS:15105 BURTON STREETTELEPHONE:
(818) 268-2651
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY: 4CENSUS: 0DATE:
09/20/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Edith MardorossiansTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
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Licensing Program Analyst (LPA) Sandra Urena conducted a Pre-licensing visit at 10:30 a.m. and met with the Applicant Edith Mardorossians. This is a new facility application for a Residential Facility or the Elderly (RCFE) four (4) non-ambulatory residents, which one can be a bedridden resident. Fire Clearance was approved on 12/14/2023 for one bedridden resident in bedroom #2. A hospice waiver was granted for four (4) residents.
At 10:35 a.m., the LPA, and the applicant 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.
KITCHEN: Kitchen knives are stored locked and inaccessible in a kitchen drawer. A seven-day supply of non-perishable food was available. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen cleaning supplies will be stored and locked in a cabinet next to the washer and dryer. Hot water temperature was recorded at 117.5 degrees Fahrenheit. Trash cans have a tight-fitting lid. There were no pesticides or toxins stored near food, or preparation area. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. A fire extinguisher is located next to the refrigerator exit, which was purchased on 03/01/2024.

BEDROOMS: There are (3) bedrooms for residents in care. Room 1 is a private room, bedroom #2 is a shared room with two beds, and bedroom #3 is a private room. One bed in bedroom #2, has half-bed rails, which need to be removed. Bedroom #2 has two collapsible closets, one for each resident as the room does not have a stationary/permanent closet. One collapsible closet sits next to five-drawer chest, which prevents easy access to the five-drawer chest. Room #3 was approved by the fire department as the bedridden bedroom. All other bedrooms are cleared for non-ambulatory. All bedrooms were supplied with all required bedding and linens. There is sufficient lighting as well as closet and drawer space available.

BATHROOMS: There are (2) full bathrooms. Bathrooms are equipped with toilet and shower grab bars. There are sufficient supplies of towels, paper goods and personal hygiene supplies. Hot water delivered at 115.5 degrees Fahrenheit. Continues on LIC 809C...

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
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: LOVING HOME INC
FACILITY NUMBER: 195850419
VISIT DATE: 09/20/2024
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COMMON AREAS: These include a living space equipped with a television. There is a dedicated area for the posting of required documents. Smoke and carbon monoxide alarms were tested and functional at the time of the visit. Medication, resident and staff files are stored and locked in cabinet in two separate cabinets in the kitchen area. LAUNDRY ROOM: Washer and dryer are located in the hallway. Detergents and cleaning supplies will be stored in locked cabinet next to the washer and dryer.
SURROUNDING GROUNDS: The exterior passageways were clean and clear of any obstructions. The patio is furnished with outdoor furniture for residents’ use, and shade is available. The building has a central entrance for residents and visitors. Fire emergency gates are clear of obstructions. Walkways behind the property and next to the front door, will have to be fenced to prevent residents wondering into these uneven ground areas. Facility address (numbers) need to be relocated to the proper building/door, so that the address numbers reelect the actual building.
The following corrections will need to be completed prior to approving licensure. Corrections will be completed by: Friday, September 27,2024.
  • Fence will added to separate front licensed facility(Loving Care Inc), from Loving Home Inc. to include an entrance gate. Facility address (numbers) need to be relocated to the proper building/door, so that the address numbers reelect the actual building.

· Bedroom #2 has two collapsible closets, one for each resident as the room does not have a stationary/permanent closet. One collapsible closet sits next to five drawer chest, which prevents easy access to the five drawer chest.
· One bed in bedroom #2, needs to have half-bed rails removed.
· Applicant will email a new sketch to Centralized Application Bureau (CAB), and Community Care Licensing (CCL) LPA to reflect the changes to the main entrance and exit path during an emergency and meeting points during an evacuation.
· Walkways behind the property and next to the front door, will have to be fenced to prevent residents wondering into these uneven ground areas.
At 1:35 p.m., the applicant completed Component III Orientation. 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 the applicant. A copy of the report was issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
LIC809 (FAS) - (06/04)
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