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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607711
Report Date: 08/28/2024
Date Signed: 08/28/2024 02:42:07 PM

Document Has Been Signed on 08/28/2024 02:42 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:OUR SWEET HOME INCFACILITY NUMBER:
197607711
ADMINISTRATOR/
DIRECTOR:		ARUTYUNYAN, TINAFACILITY TYPE:
740
ADDRESS:16518 DEVONSHIRE STTELEPHONE:
(818) 970-9586
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 5DATE:
08/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:06 AM
MET WITH: Tina ArutyunyanTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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In conjunction with a complaint investigation (complaint control #31-AS-20240723091150) Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Tina Arutyunyan, and explained the reason for the visit.

At approximately 11:06am, with the assistance of the administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are battery operated. The carbon monoxide detector, that is installed in the dining room, functions properly. The fire extinguisher is located in the kitchen. It was purchased on September 12, 2023.

Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. No cleaning supplies were observed present in the kitchen during the day's inspection.

Bedrooms: There are six (6) bedrooms, of which five (5) bedrooms are designated for residents' use. Room #5 is a shared room. Rooms 1 to 4 are private. LPA observed rooms that are occupied by the residents to be properly furnished with appropriate beddings and linens and sufficient lighting. There is one room, designated for staff use.

Bathrooms: There are three (3) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured between 111 and 115 degrees Fahrenheit.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: OUR SWEET HOME INC
FACILITY NUMBER: 197607711
VISIT DATE: 08/28/2024
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Common Areas: These included the living room, family room and dining area. The living room, located at the front entrance, is furnished with a couch and table with four additional chairs. The fireplace in the living room is non-functional. There is a screen and a glass door in place. No fireplace tools were present. The family room has three couches and a television. The dining room table was large enough to seat up to six (6) residents. Floors were mopped and clean. Passageways and hallways were clear of obstruction. The auditory alarms on all exit doors were tested and functional at the time of the visit.

Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor
use. The outdoor area was free of hazards.

Laundry Area: The laundry area is located by the living room. Detergents and cleaning supplies were kept locked.

Resident Files: Resident files are kept secured in the medication cabinet, located at the kitchen. LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: Staff files are also kept secured in the medication cabinet. LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: The medication cabinet is located in the kitchen. It was observed locked during the visit. Medication and Medication Records were review for storage and documentation. documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the day's visit. Exit Interview Conducted and a Copy of this Report Issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
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