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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609001
Report Date: 11/21/2024
Date Signed: 11/21/2024 07:38:24 PM

Document Has Been Signed on 11/21/2024 07:38 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ROYALTY ASSISTED LIVINGFACILITY NUMBER:
197609001
ADMINISTRATOR/
DIRECTOR:
AVETIAN, LIDUSHFACILITY TYPE:
740
ADDRESS:10940 STRATHERN STREETTELEPHONE:
(818) 436-9088
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 10CENSUS: 9DATE:
11/21/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:51 PM
MET WITH:Estela Avetyan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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Licensing Program Analyst, (LPA) Leizl de la Cerra, made an unannounced site visit to this facility as a continuation of the Required 1 Year Annual Inspection conducted on 11/13/2024. LPA met with caregiver, Karine, and the purpose of visit was disclosed. The administrator was contacted, who arrived shortly thereafter.

The following remaining inspection domains were observed, reviewed and inspected:

Staff records: LPA conducted records review of the facility staff . LPA reviewed three (3) staff records to insure compliance.

Medications: Residents medication are centrally stored in the medication room which is inaccessible to residents. Two (2) centrally stored resident medications were reviewed. First Aid kit is complete.


Exit interview conducted and a copy of the report was signed by administrator. Copy of report was issued..

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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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