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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197604809
Report Date: 04/29/2024
Date Signed: 04/29/2024 05:08:28 PM

Document Has Been Signed on 04/29/2024 05:08 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:CHATEAU MAGNOLIAFACILITY NUMBER:
197604809
ADMINISTRATOR/
DIRECTOR:		KARINE FILIKYANFACILITY TYPE:
740
ADDRESS:1061 EAST MAGNOLIA ST.TELEPHONE:
(818) 843-5873
CITY:BURBANKSTATE: CAZIP CODE:
91501
CAPACITY: 6CENSUS: 2DATE:
04/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Nvard Meymaryan, Administrator AssistantTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Antonia Alvizar conducted an unannounced Annual Required visit to this facility. LPA met with Administrator Assistant and explained the reason for the visit.

At 1:50p.m. Administrator Assistant and LPA tour of the physical plant for compliance with safety, maintenance, and operational requirements. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Facility is a single-story house in a residential neighborhood and consisting of a common area, six (6) bedrooms, two (2) full bathroom and currently occupied with two (2) residents. There is one entrance being utilized at the facility, there are required posters at the main door. Smoke detectors and Carbon Monoxide detectors were tested and function properly. Facility disaster drills was conducted on 01/30/2024. The facility maintains a comfortable temperature at 72°F. Hot water temperature was tested in bathrooms and in the kitchen. The hot water temperatures measured between 117.3 - 118.5 degrees Fahrenheit (F) which are within the required range for residents comfort and safety.

Kitchen: The kitchen appeared clean and fixtures functional. Kitchen knives and other sharp items are stored in a lock drawer in the kitchen. The supply of dishes and eating utensils was more than adequate. Resident medication, resident and staff records are kept locked in cabinet. All toxins are stored in a locked cabinet inaccessible to clients in care. Fully charged fire extinguisher is located in the kitchen.

Bedrooms: The residents’ bedrooms were properly furnished and had adequate lighting and closet space. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2024
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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CHATEAU MAGNOLIA
FACILITY NUMBER: 197604809
VISIT DATE: 04/29/2024
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Bathrooms: LPA observed all bathrooms to be clean, properly supplied and had functional fixtures. LPA observed grab bars in both bathrooms. The bathroom had non-skid mat in shower. Residents have enough personal hygiene supplies.



Common Areas: The living room has a television, three (3) couch, three (3) recliner chairs and a functional telephone. The common areas were checked for cleanliness and furniture was checked for functionality. All areas were clean, sanitary and in good repair. Living room was observed to have a cover fireplace. At 4:00p.m. LPA observed residents resting in their bedroom.

Surrounding Grounds (Outdoors): There was a shaded area with proper furniture for outdoor use in the back patio. There are no bodies of water and firearms on the premises.

Garage: Detached located in the rear of the facility, which stores personal protected equipment (PPE), emergency food, maintenance supplies, resident diapers, extra personal hygiene, detergent, cleaning supplies, two (2) operation refrigerators with extra Non-perishable and perishable food. Garage is kept locked and inaccessible to residents at all times.

Per California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, deficiencies were not observed/cited. Exit interview conducted and copy of report provided to Administrator Assistant .

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
LIC809 (FAS) - (06/04)
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