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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608568
Report Date: 04/15/2024
Date Signed: 04/17/2024 09:03:24 AM

Document Has Been Signed on 04/17/2024 09:03 AM - 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:ADL BEST CARE 2FACILITY NUMBER:
197608568
ADMINISTRATOR/
DIRECTOR:		ANNA VARDANYANFACILITY TYPE:
740
ADDRESS:5431 MONROE STREETTELEPHONE:
(323) 461-5602
CITY:LOS ANGELESSTATE: CAZIP CODE:
90038
CAPACITY: 5CENSUS: 5DATE:
04/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:42 AM
MET WITH:Anna VardanyanTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 04/15/24, 8:30 AM Licensing Program Analyst (LPA) Raymond Comer conducted a required unannounced Annual visit to this facility. LPA met with Facility Administrator, Anna Vardanyan, and reason for the visit was discussed. Facility is licensed as a single-story residence, Five (5) non-Ambulatory. Hospice waiver for five (5). Facility has three (3) resident bedrooms and two (2) bathrooms.

At 12:20 PM, LPA conducted a tour of the physical plant with the Administrator and observed the following:

PHYSICAL PLANT was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access. Screening area is located immediately upon entrance. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Covid 19 prevention protocols are posted. Hand washing, coughing etiquette, and other necessary signage are posted throughout the facility. Room temperature is comfortable; wall thermostat displays a setting of 72.0°F. within the required range. Side door is located west of house, exiting to back yard. All trash cans were observed to be covered. The facility has submitted an approved Mitigation and Infection Control plan. Required postings are prominently displayed and observed to be current at the facility. Disaster drills were last conducted on 3/01/2024.

COMMON AREAS: Entry and exit doors have a functional auditory alert when the doors open. Dining room is furnished with table large enough to accommodate the capacity of the facility, sitting area, television, stored games, reading materials. Furniture and fixtures are clean and good condition. Facility telephone was operational at time of visit.

LIC 809C-continued
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2024
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 3
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: ADL BEST CARE 2
FACILITY NUMBER: 197608568
VISIT DATE: 04/15/2024
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KITCHEN area is clean and clear of clutter. LPA observed refrigerator, microwave, stove/oven, dishwasher and sink to be operational. Knives/Sharps are stored in a locked top kitchen drawer inaccessible to residents. Plates, cups, utensils, and two-day supply of perishable food is properly stored and labeled. A seven day supply of nonperishable food is located in detached garage and properly stored. Dish Soap, cleaning solutions, and toxins are stored in locked lower cabinet underneath the kitchen sink.

FIRE DETECTION/SUPPRESSION SYSTEMS are present at facility. Multiple combination smoke\ carbon monoxide alarm detectors are installed, hardwired and interconnected. Combination Smoke and Carbon monoxide detectors were tested and function properly. Fire extinguisher is located on wall near the dining room and hallway area; purchase inspection service date: 04/06/2024.

BEDROOMS: Bedroom#1 is a private resident room. Bedroom#2 and Bedroom#3 are shared resident rooms. All Bedrooms are observed as clean with sufficient lighting, properly furnished with bedding, linens, at least one chair, and night stand.

BATHROOMS were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 109°F. Within the required range.

GARAGE is detached from the house and observed to be locked and inaccessible to residents. Garage is a storage for extra water, additional linens, towels, and PPE supplies. It is also equipped with an additional refrigerator containing stored perishable foods.

OUTDOORS: (backyard) area observed to have a shaded patio, with tables with sufficient seating for the residents. Patio furniture observed to be in good condition. A room behind the facility is an office space. Office contains an additional refrigerator which stores resident food. Office is observed to be locked and inaccessible to residents. The facility has a rock fountain enclosed in a 3-ft. gate and observed as dry and not in use. There are no bodies of water in the facility.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ADL BEST CARE 2
FACILITY NUMBER: 197608568
VISIT DATE: 04/15/2024
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RESIDENT RECORDS are stored in secure and locked file cabinet in dining room area and inaccessible to residents. Records were reviewed for current IPP and/or Needs and Services plans, physician report, and admission agreements. Resident records appear to be complete and current.

STAFF RECORDS are stored in secure and locked cabinets in office area and are inaccessible to residents. Records were checked for criminal record clearances\associations to this facility. Staff records appear to be complete and current.

No immediate health and safety hazards observed during the day of inspection. Exit interview conducted and a copy of this report was given.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024
LIC809 (FAS) - (06/04)
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