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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608325
Report Date: 09/09/2021
Date Signed: 09/09/2021 12:38:20 PM

Document Has Been Signed on 09/09/2021 12:38 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:ZANN DAILY CAREFACILITY NUMBER:
197608325
ADMINISTRATOR:ANN SOLAKYANFACILITY TYPE:
740
ADDRESS:11500 BAIRD AVENUETELEPHONE:
(818) 635-9471
CITY:NORTHRIDGESTATE: CAZIP CODE:
91326
CAPACITY: 6CENSUS: 5DATE:
09/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Ann SolakyanTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility 1130am to conduct an unannounced infection control inspection/visit. Upon arriving, LPA was greeted by caregiver, who allowed LPA to enter the facility. There have not been any active or past COVID cases at the facility, and (3) staff and (5) residents have been vaccinated. The current census is (5). Administrator Ann Solakyan arrived shortly after, and was informed the reason of the visit. .LPA temperature was taken, and LPA observed the visitors sign in sheet and cleaning table, with hand sanitizer. COVID-19, CDC, Department of Public Health, and Licensing postings on the walls throughout the facility.

The infection control inspection began with the Administrator, who escorted LPA throughout the facility. The facility has (7) private bedrooms; with (1) room for staff, and all bedrooms were properly furnished. The common areas were observed to be clean, including bathrooms, with soap and towels, and hand washing signs visually posted. LPA conducted a mitigation plan review with the Administrator to obtain information on how the facility has implemented the department's mitigation plan.

The Administrator reported to LPA, the facility has documentation of all vaccination records and other pertinent information pertaining to COVID-19, in staff and resident files. All new employee hires and new resident admits, will be properly screened, and provided a negative COVID test, prior to entering the facility. Administrators reported to reading the departmental emails and continues to provide and conduct training to staff in relation to COVID-19. There is currently no paid sick leave policy in place. LPA discussed with the Administrator, that even though, everyone in the facility has been vaccinated, there needs to be a sick leave policy in place for staff, that is flexible and not punitive.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2021
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: ZANN DAILY CARE
FACILITY NUMBER: 197608325
VISIT DATE: 09/09/2021
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The facility does have staffing issues, but Administrator has a plan in place, and is currently hiring and reviewing applicants for new employees. There are designated rooms for potential positive COVID residents because the facility has private rooms.

PPE supplies were inspected, and Administrator reported to LPA that the supplies are kept in the garage area. It's replenished as often as needed, based on the request of staff. Chemicals, cleaning supplies, paper products were observed and locked and secured in the garage. Administrator informed LPA that they continue to implement the best practices for their facility, which has kept them COVID-19 free. The facility is aware to report any changes with residents and staff to Licensing and there LPA, pertaining to positive COVID-19 cases.

Exit interview conducted and copy of report was provided.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
LIC809 (FAS) - (06/04)
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