197608325-9-26-2022-31-AS-TSMH-CJMRYR-20220926132647

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608325
Report Date: 09/26/2022
Date Signed: 09/26/2022 01:26:53 PM

Document Has Been Signed on 09/26/2022 01:26 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 CARE		FACILITY NUMBER:	197608325
ADMINISTRATOR:	ANN SOLAKYAN		FACILITY TYPE:	740
ADDRESS:	11500 BAIRD AVENUE		TELEPHONE:	(818) 635-9471
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91326
CAPACITY: 6		CENSUS: 6	DATE:	09/26/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:19 AM
MET WITH:	ANN SOLAKYAN		TIME COMPLETED:	01:36 PM

NARRATIVE

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Licensing Program Analyst (LPA) Tihesha “Lynn” Smith conducted an unannounced Annual Required/infection control visit to this facility at 10:19 am. LPA Smiths’ temperature taken upon entry and Covid symptoms follow-up questions on sign-in sheet. LPA informed staff the purpose of this visit. The administrator was called. Administrator authorized caregiver Svetlana Tumanyan to sign report in administrators absence.

LPA conducted a tour at 11:00 AM of the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

LPA was escorted to the living and dining combination area and observed adequate seating for residents. Staff confirmed there are six (6) clients in the home. The living area had furnishings, sufficient lighting and the area was clean.

Smoke alarms and carbon monoxide detectors were present and function properly. The two (2) fire extinguishers located in kitchen on counter and in dining room attached to wall observed to be charged.

LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the six (6) clients currently residing there. Two (2) days of perishable fruits, vegetables, milk, and eggs observed with juice. The freezer is stocked with meats and extra water/juice stored in hall closet #1..

Sharps observed to be locked in lockbox stored in bottom kitchen cabinet and observed to be inaccessible to clients. All the toxins, cleaning solutions and disinfectants are stored in locked garage and observed to be in accessible to clients. Laundry area located in garage. Appliances observed to be in good repair.

Medications are locked in hall closet #2. Medications observed to be locked and inaccessible to clients. LPA observed fully stocked first aid kit locked in medication closet with facility, staff, and client files

(Cont to 809C)

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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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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: 09/26/2022

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(Cont. from 809)

There are six (6) bedrooms. A tour of the client’s bedrooms, bathrooms, personal accommodations, and common areas (all resident bedrooms toured had the required furniture for residents’ comfort and safety). Common areas were observed for the ability to safely serve the needs of residents, including cleanliness, skid materials, locks, grab bars, and comfortable temperatures. LPA observed a sufficient supply of linens and PPEs in garage.

There are two (2) bathrooms: one (1) bathroom in hallway near front of house and one (1) bathroom in room #5. Each bathroom has posted “wash your hands” sign and the following items available: hand soap, paper towels, and trash cans. The hot water temperature was measured for the two (2) bathrooms to ensure it is within the required range for residents’ comfort and safety. The water temperature range was between 110- and 111.8-degrees Fahrenheit.

The backyard has the following: a patio table and chairs shaded by a large umbrella for clients use including a 2^nd sitting area on the side of house. Patio furniture observed to be in good repair with adequate seating for the residents. There is a pool enclosed by a gate. Gate to the pool observed to be locked and inaccessible to clients.

There were no immediate health and safety risks observed during the day of inspection. There are no deficiencies to report.

Exit interview conducted and a copy of this report was given.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

LIC809 (FAS) - (06/04)

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