<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609001
Report Date: 10/31/2022
Date Signed: 10/31/2022 11:42:25 AM

Document Has Been Signed on 10/31/2022 11:42 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ROYALTY ASSISTED LIVINGFACILITY NUMBER:
197609001
ADMINISTRATOR:AVETIAN, LIDUSHFACILITY TYPE:
740
ADDRESS:10940 STRATHERN STREETTELEPHONE:
(818) 436-9088
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 10CENSUS: 10DATE:
10/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kara CharchaogalyanTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced infection control inspection/visit. Upon arriving, LPA was greeted by caregiver Kara Charchaogalyan, who allowed LPA to enter the facility; she was informed the reason of the visit. There have not been any active or past COVID cases at the facility, and staff and residents have been vaccinated. The current census is (10). LPA observed the visitors sign in sheet and cleaning table, with hand sanitizer. Licensee Lidush Avetian was contacted, but not able to attend the inspection. She was informed the reason of the visit. .

The physical plant infection control inspection began with the caregiver Kara, who escorted LPA throughout the facility. The facility has (7) private bedrooms; with (1) room for staff, and (1) empty room, with no clients, that will be used for isolation if needed for COVID clients. All bedrooms were properly furnished, and beds were (6) feet apart. The common areas were observed to be clean, including bathrooms, with soap and towels, and hand washing signs visually posted.

Kara reported to LPA, currently there are only (4) clients that are vaccinated, and the remaining (10) refused. All staff, including Administrator and Licensee are vaccinated; no-one has received the booster. Facility has documentation of all vaccination records and other pertinent information pertaining to COVID-19, in staff and resident files. Clients are enrolled with the agency PACE, who provide day program services and transport for medical appointments, etc, ensure clients are weekly tested for COVID. Facility will continue to practice, all new employee hires and new resident admits, will be properly screened, and provided a negative COVID test, prior to entering the facility.



The designated infection control lead continues to be the Administrator Stella Avetyan. The facility does not have staffing issues, due to having a plan in place.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2022
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 2
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: ROYALTY ASSISTED LIVING
FACILITY NUMBER: 197609001
VISIT DATE: 10/31/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Chemicals, cleaning supplies, paper products were observed and locked and secured. Licensee informed LPA that they continue to implement the best practices for their facility, which has kept them COVID-19 free, since the beginning of the pandemic. 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 was conducted and copy of report provided.

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

DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2