195850497-5-7-2024-29-AS-VCOY-D52LXE-20240507090835

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850497
Report Date: 05/06/2024
Date Signed: 05/07/2024 09:08:42 AM

Document Has Been Signed on 05/07/2024 09:08 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	VALLEY'S BEST HOMECARE		FACILITY NUMBER:	195850497
ADMINISTRATOR/ DIRECTOR:	KUYUMCHYAN, GAMLET		FACILITY TYPE:	740
ADDRESS:	6236 HALBRENT AVENUE		TELEPHONE:	(818) 472-9945
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91411
CAPACITY: 6		CENSUS: 0	DATE:	05/06/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:05 AM
MET WITH:	Gamlet Kuyumchyan		TIME VISIT/ INSPECTION COMPLETED:	01:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Valeria Conway arrived at the facility at 9:06 a.m. to conduct a Pre-Licensing Inspection. The LPA met with Administrator Gamlet Kuyumchyan and Caregiver Liana Atabekyan. This is a change of location for currently licensed facility Valley’s Best HomeCare #197608599. Hospice waiver was granted for four (4) residents on 04/18/24. There are currently no residents being served at the facility. A Fire Clearance was granted on 02/22/2024 for a total of six (6) residents of which four (4) maybe ambulatory, one (1) non-ambulatory and one (1) maybe bedridden. The proposed physical plant is a one (1) story single family dwelling located in a residential neighborhood of Van Nuys, CA. At 9:23 a.m. tour of the physical plant was conducted and the following observed: Bedrooms: The facility has three (3) shared bedrooms designated for resident use only. Bedroom #1 and is designated for one (1) non-ambulatory and one (1) bedridden resident and rooms # two (2) and three (3) are designated for two (2) ambulatory residents each. There is one (1) staff room with two (2) beds for staff use only. All bedrooms were equipped and supplied with appropriate furniture, bedding, and linens. LPA observed a flashlight inside a drawer in each nightstand tables in every room. There were no visible hazards or discrepancies observed. Bathrooms: There are two (2) bathrooms, one at the end of the hallway for residents and staff use and one (1) inside the master bedroom (room #3). LPA observed grab bars for each toilet, and shower used by resident. All bathrooms were supplied with appropriate paper and hygiene products. At approximately 9:27 a.m., water temperatures measured within the required range of 105 degrees F to 120 degrees F at the time of the visit. Continued on LIC 809-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

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: VALLEY'S BEST HOMECARE	FACILITY NUMBER: 195850497
	VISIT DATE: 05/06/2024

NARRATIVE

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Continued from LIC 809

Common Areas: These include the Family Room and Dining Room. The common areas were furnished to accommodate a maximum capacity of six (6) residents. Floor surfaces were clean and in good repair. There were no immediate hazards observed. Fire extinguisher was observed in the kitchen; LPA observed it to be fully charged and last serviced 05/01/2024. At 10:00 a.m., hardwired combination carbon monoxide/smoke detectors were tested and were functional at the time of the visit. LPA didn’t observe a fireplace at the time of the visit. There are cameras with out audio in all common areas. Posters were observed all throughout the facility including personal rights notice, ombudsman, and information about how to report a compliant to CCL.

Kitchen: Appliances and fixtures appeared clean and functional. There was sufficient dining and cook ware to accommodate a maximum capacity of six (6) residents. Facility doesn’t have many perishable items nor fresh fruit because there are no residents at the time of the visit. Knives and other sharps will be stored in locked safe box inside a kitchen drawer on the left side of the kitchen counter. Cleaning supplies soaps and detergents are locked under-sink cabinets and shall be stored in areas separated from food supplies. There were no visible immediate hazards observed. Community phone and internet access is provided by the administrator to the residents.

Laundry Area: It is adjacent to the bathroom at the end of the hallway. Laundry room will be always locked and inaccessible to residents, staff will assist clients with all laundry needs. Entrance is only from the outside of building.

Backhouse/Staff room/Office: There is a backhouse detached from the main construction. Clients are not allowed into that space. Administrator and caregiver explained that nobody will be living there, space will be utilized as an office when need it. There is a bathroom for staff only. Sufficient amount of emergency water and non-perishable food was observed to accommodate a maximum capacity of 6 Clients for (seven) 7 days. There is second floor with a small door accessible with a ladder only that will take you to the attic. That space is insulated and only for ducts for the back house HVAC system.

Continued on LIC 809-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

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: VALLEY'S BEST HOMECARE	FACILITY NUMBER: 195850497
	VISIT DATE: 05/06/2024

NARRATIVE

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Continued from LIC 809-C

Surrounding Grounds: The front yard includes a driveway, paved walkways, and landscaped areas. The backyard is fenced and includes both paved and landscaped areas, a covered patio, furniture appropriate for outdoor use. There are two (2) side gate doors with self-latching mechanisms. All outdoor and indoor passageways were observed free of obstruction at the time of the visit. LPA observed all ramps and open porches to be equipped with sturdy hand railings and well-lighted. All window screens were cleaned and maintained in good repair. Backyard: There is a locked storage in the backyard that holds cleaning supplies, disinfectant, and laundry detergent. Cleaning supplies and detergents were observed locked and inaccessible to residents. There is a garage door that will remain locked. There is sufficient space for outdoor activities, a large furnished area to all residents to relax and entertain friends and family.

Medical Area: Medications are stored in a locked medication cart, right outside the staff room. There is a complete first aid kit on top of the medication cart which it will be properly supervised by staff at all times. Staff will be using LIC 622 (Centrally Stored Medication and Destruction Record) once facility receives first resident.

The following needs to be completed/Photos sent to LPAs prior to licensure:

 Fix hole inside closet ceiling in bedroom #2.
 New facility sketch showing laundry room, back house, and covered patio.

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 conducted. A copy of the Licensing Report was issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

LIC809 (FAS) - (06/04)

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