<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850498
Report Date: 12/04/2024
Date Signed: 12/04/2024 11:26:21 AM

Document Has Been Signed on 12/04/2024 11:26 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:VARNA ASSISTED LIVINGFACILITY NUMBER:
195850498
ADMINISTRATOR/
DIRECTOR:		SAHAKYAN, SAHAKFACILITY TYPE:
740
ADDRESS:6848 VARNA AVENUETELEPHONE:
(818) 395-4141
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 6CENSUS: 0DATE:
12/04/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:39 AM
MET WITH:Sahak SahakyanTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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) Angela Barutyan conducted a pre-licensing visit to the facility noted above at 09:39AM. LPA met with Administrator Sahak Sahakyan. The applicant has obtained fire clearance for a total capacity of six (6) residents.

LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. The facility is one story. The facility has three (3) shared resident bedrooms. There is an ADU on the premises where staff will stay. All resident bedrooms are cleared for nonambulatory only. The combination smoke alarm/carbon monoxide detectors and fire door were tested and functioned properly. LPA observed two (2) fire extinguisher to be fully charged and purchased on 06/07/2024.

LPA toured the kitchen area at approximately 09:48AM. The hot water temperature was measured in the kitchen sink, and it measured 106.0 degrees Fahrenheit. Appliances and all equipment appear to be clean and in good repair. The kitchen has a sufficient supply of plates, cups, cookware, utensils, and non-perishable foods. Kitchen knives and sharps are locked in a cabinet drawer.

Resident bedrooms are equipped with clean mattresses, pillows, and bedding. Bedrooms have sufficient lighting. There is a sufficient supply of linens, including blankets, bath towels and wash cloths. The facility has two (2) bathrooms for resident use; one (1) is in the hallway and one (1) is attached to bedroom #3. Bathrooms contained appropriate slip-resistant surfaces and grab bars. Hot water temperature was measured in all bathrooms, and they measured between 107.8 – 108.0 degrees Fahrenheit, which is within the required range. LPA observed trash cans with tight fitting lids at the time of the visit.

Report Continued on LIC 809C...

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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 2
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: VARNA ASSISTED LIVING
FACILITY NUMBER: 195850498
VISIT DATE: 12/04/2024
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
26
27
28
29
30
31
32
Report Continued from LIC 809C...

The living areas and dining areas are clean and properly furnished. All window screens and coverings are in good repair. LPA observed enough seating for six (6) residents at the same time in the dining room table. A working telephone is present. There are activity supplies in the living room. There is one (1) fireplace which was observed adequately screened. Night-lights were present in the hallways. Medications will be stored and locked in a cabinet in the hallway. LPA observed emergency food and water supply, and clean linens and towels in the hallway closets. Facility records and First aid kit will be by the office area in the living room. First aid kit was observed to have bandages, thermometer, scissors, tweezers and a current first aid manual.

Additional cleaning supplies, toxins, detergents, disinfectants, and cleaning supplies, were stored locked in the laundry area by the kitchen and in locked sheds outside. There will be no firearms/ammunition stored on the property. The facility has required postings, including Emergency Exit Plan, Licensing Complaint Poster, Resident Personal Rights, and Theft and Loss Policy.

The exterior passageways were free of obstructions. Emergency side gate will be self-closing and self-latching. LPA observed a gated and locked pool in the backyard that is inaccessible. LPA observed the backyard, which has a covered outdoor area with a table and chairs for client use. There are locked sheds containing additional supplies. Cameras were observed in the outside perimeter only. Auditory exit alarms were functioning properly.

Physical plant is consistent with the submitted facility sketch/floor plan.

Comp III conducted with Administrator..

Pre-Licensing is complete and this facility has no deficiencies.

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. The report was reviewed, and a copy was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2