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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197604809
Report Date: 01/27/2025
Date Signed: 01/27/2025 12:58:38 PM

Document Has Been Signed on 01/27/2025 12:58 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: 4DATE:
01/27/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Karine Filikyan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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On 1/27/25, at 9:40am, Licensing Program Analyst, (LPA) Gina Saucedo, conducted an unannounced visit to the above facility to check on the residents who were evacuated due to the current fires that took place. LPA was greeted by Caregiver, Gohar Petrosyan and disclosed the reason for their visit. The Administrator, Karine Filikyan was called and arrived about twenty (20) minutes after.

The facility originally accepted a total of three (3) residents from Eaton Canyon Villa I (197609785) and Eaton Canyon Villa II, INC (197610122). The facilities had a mandatory evacuation due to the fires. The residents transported to this facility were transported with their medication and additional staff to assist. A physical plant tour was conducted to ensure the health and safety of all residents. Two (residents) have been moved/transferred out from the above facility that were originally evacuated from the fires. There is only (1) resident that currently residing at the above facility.

LPA observed the following:

Facility is a single-story house consisting of a total of six (6) bedrooms, two (2) full bathroom and currently occupied with three (3) residents plus one (1) from the evacuation total of four (4). There is one entrance being utilized at the facility, there are required posters on your left side of the facility against the wall and the Ombudsman sign on your right-hand side. Smoke detectors and Carbon Monoxide detectors were tested and function properly.



Relocated residents:

There is one (1) resident that is still residing at the above address who has been placed in a single room with proper bedding, nightstand, chair, and lighting and television. LPA observed bedding and furniture in proper condition. Sufficient supplies of hygiene observed for the resident.

LIC 809C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2025
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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CHATEAU MAGNOLIA
FACILITY NUMBER: 197604809
VISIT DATE: 01/27/2025
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Bedrooms: The other three (3) residents’ from the above facility have their private bedrooms which are properly furnished and have adequate lighting and closet space. The bedrooms have appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, blankets and television.

Bathrooms: LPA observed two (2) 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.



The Kitchen: LPA observed sufficient stock of seven (7) day non-perishable and perishable foods. LPA observed enough chairs and tables in the dining area to accommodate the additional residents who were transferred. Administrator from the above facility stated they were able to provide their own food to the other residents that were transferred and to help accommodate during evacuation orders.

Outside: There was a shaded area with proper furniture for outdoor use in the back patio. There are no bodies of water.



Garage: There is also a garage in the back of the house.


No Immediate Health and Safety issues observed. Exist interview conducted and a copy of this report was given to the Administrator.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC809 (FAS) - (06/04)
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