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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608083
Report Date: 05/17/2022
Date Signed: 05/17/2022 12:52:56 PM

Document Has Been Signed on 05/17/2022 12:52 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 INC #2FACILITY NUMBER:
197608083
ADMINISTRATOR:ARUTYUNYAN, TINAFACILITY TYPE:
740
ADDRESS:10150 MELVIN AVETELEPHONE:
(818) 970-9586
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 6CENSUS: 4DATE:
05/17/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Tina ArutyunyanTIME COMPLETED:
12:45 PM
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Licensing Program Analysts (LPAs) Tuesday Cabiness and Joselyn Martinez conducted a POC visit and met with Administrator Tina Arutyunyan who was informed the reason of the visit. The reason of today's visit, was to clear the citations/deficiencies that were issued during the office meeting on 04/26/2022. The Administrator submitted the POC's when they were due on 05/10/2022, and LPA re-reviewed and discussed with the Administrator the documents and cleared the plan of corrections.

Administrator informed LPA, that the new banking account that was opened, will be used for P&I purposes only, and was opened under the corporation of Our Sweet Home. LPA reviewed the banking document, in which the amount for R1 for Our Sweet Home # 2, was deposited. According to the Administrator, because the account is new, she has to wait for the first banking statement, which will be issued in (30) days. Once the Administrator has the statement, she will submit a new LIC405, (Record of Client/Resident's Safeguarded Cash Resources) form for resident # 1 (R1), showing the amount of money that is owed for R1. The Administrator will ensure, that R1 is aware of the balance, with a date and signature from R1 and the Administrator. The Administrator will submit a copy of the new P&I log for R1, attached with the banking statement and submit to LPA. Administrator informed LPA that R1 is able to handle R1's own finances, and she will no longer be responsible for R1's personal expenses. Administrator also stated, that she will not keep petty cash at the facility, since the resident will be given the money monthly. LPA also received the Administrator's statement that was required, regarding how moving forward, P&I will be disbursed for R1. LPA will follow up with Administrator within the next couple of weeks, for the bank statement and the signed P&I log for R1.

Exit interview conducted.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2022
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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