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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850571
Report Date: 01/22/2025
Date Signed: 01/22/2025 04:44:19 PM

Document Has Been Signed on 01/22/2025 04:44 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:SWEET APPLE ASSISTED LIVINGFACILITY NUMBER:
195850571
ADMINISTRATOR/
DIRECTOR:		AVETISYAN, ARMINEFACILITY TYPE:
740
ADDRESS:6858 AMESTOY AVENUETELEPHONE:
(702) 601-2178
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 6CENSUS: 0DATE:
01/22/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Armine Avetisyan. TIME VISIT/
INSPECTION COMPLETED:
12:30 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) Sandra Urena conducted a Pre-licensing visit and met with the applicant Armine Avetisyan. This is a new facility application for a Residential Facility for the Elderly (RCFE) for six (6) residents. Fire Clearance was approved on 11/14/2024 for one (1) ambulatory in bedroom#1, and five (5) bedridden residents only in bedrooms #2, #3, and #4.

At 9:30 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 that the facility will be following Title 22 Regulations.

KITCHEN: Kitchen knives are stored locked and inaccessible in a locked closet. 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 locked closet in the common area. Hot water temperature was recorded at 118.5 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 near the backdoor, which was purchased on 08/09/2024.

BEDROOMS: There are four (4) bedrooms for residents in care. Bedroom #1 was approved for (1) ambulatory resident and bedrooms # 2, 3 and 4 were approved for five (5) bedridden residents only. There is sufficient lighting as well as closet space available. Chest of drawers will be purchased for each bedroom (1,2,3,4).


BATHROOMS: There are three (3) full bathrooms, with shower area. One of the three bathrooms is located in the hallway, one is located in bedroom #1 and another one is located in bedroom#3. Bathrooms are equipped with toilets and shower grab bars, and non-skid mats. There are sufficient supplies of towels, paper goods and personal hygiene supplies. Hot water delivered was measured at 118.2 degrees Fahrenheit

Continues on LIC 809C..

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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: SWEET APPLE ASSISTED LIVING
FACILITY NUMBER: 195850571
VISIT DATE: 01/22/2025
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
COMMON AREAS: These include a living room area equipped with a television. There is a dedicated area for the posting of required documents at the entrance of the facility. Smoke and carbon monoxide alarms were tested and functional at the time of the visit. Medications will be stored in a locked closet located next to the refrigerator in the kitchen area. The residents’ and staff files will be stored and locked in a closet area located next to the kitchen. The hallway door will require a magnet to keep door open and be activated during a fire. LAUNDRY ROOM: There is a laundry area equipped with washer and dryer. The laundry room is located in the hallway. Detergents and cleaning supplies will be stored in locked closet located next to bedroom #1.

SURROUNDING GROUNDS: The exterior passageways were clean. The patio is furnished with outdoor furniture for residents’ use, and shade is available. The building has a central entrance for residents and visitors. The backdoor requires a ramp with handrails to provide access to the residents to get to the backyard/outdoor area. At the time of the visit the LPA observed two ADU units. One unit is identified by the address #6854 and is located on the left-hand side of the facility, it is fully enclosed with fencing at least 6’ feet tall. The second ADU is identified by the address #6854 and is located behind the facility and is separated by fencing at least 6’ feet tall. Neither ADU’s are associated with the facility.



Pre-Licensing is incomplete with deficiencies to be resolved by Friday, 01/31/2025. Follow up Pre-licensure LIC809 will be generated upon resolution.

· Chest of drawers will be purchased for each bedroom (1,2,3,4).

· The backdoor requires a ramp with handrails to provide access to the residents to get to the backyard/outdoor area.

· The hallway door will require a magnet to keep door open and be activated during a fire.



At 12:15 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.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2