197609038-1-19-2023-31-AS-JGTN-CN8VKC-20230119153006

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609038
Report Date: 01/19/2023
Date Signed: 01/19/2023 03:30:17 PM

Document Has Been Signed on 01/19/2023 03:30 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:	FLAIR SENIOR MANOR 2		FACILITY NUMBER:	197609038
ADMINISTRATOR:	PAYARALI, LILIYA		FACILITY TYPE:	740
ADDRESS:	22853 ENADIA WAY		TELEPHONE:	(818) 610-1015
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY: 6		CENSUS: 5	DATE:	01/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:16 PM
MET WITH:	Liliya Payarali - Administrator		TIME COMPLETED:	03:30 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) Gary Tan conducted an unannounced One (1) year Required Infection Control visit at this facility. LPA met with administrator Liliya Payarali and explained the purpose of this visit. A tour of the physical plant was conducted at 1:23 PM and the following was observed: The facility has one main entrance being used, the main door has required Covid-19 prevention signage (hand washing, coughing etiquette and physical distancing) are posted on the door. The PPE screening station is located immediately upon entrance and had a table equipped with sufficient PPE readily accessible, a thermometer, hand sanitizer, gloves, mask and sign in sheet at the time of visit. Visitors are required to wear mask. The facility has an approved mitigation plan on file. The facility is a single storey building and has six (6) bedrooms and four (4) bathrooms. One (1) bedroom and one (1) bathroom is designated for staff use. Fire cleared for five (5) non-ambulatory residents, one (1) of which maybe bedridden on Room #3 or #5. Hospice waiver for two(2) residents. Living and dining room furniture were checked. The living room is neat and clean along with the dining room. Furniture were observed to be in good repair and excellent condition. The facility maintains a comfortable temperature at 73°F. The dual smoke alarms are hardwired and interconnected and observed to be operational. There is a carbon monoxide detector installed in the facility. Fire extinguisher is located in the kitchen and observed to be last inspected on 05/17/22. (continued on LIC 809-C)

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

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: FLAIR SENIOR MANOR 2	FACILITY NUMBER: 197609038
	VISIT DATE: 01/19/2023

NARRATIVE

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(continued from LIC 809)

Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in the kitchen drawer and inaccessible to residents. Laundry room is located in the bedroom hallway. Laundry detergent, cleaning solutions and other toxins are observed to be locked inside the laundry room.

The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee.

The Bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was checked and measured at a range of 114.5°F to 115.6°F. Towels and washcloths are not shared. There were enough clean linen available in stock at the cabinet.

Medications: LPA observed that the medication are kept in the cabinet in the living room area and was observed to be locked and inaccessible to residents. There was a complete first aid kit located on top of the medication cabinet.

Garage: There is no garage at the facility only drive ways at the back.

The Backyard had a covered shaded area for clients with outdoor furniture. There is no body of water at the facility.

Exit interview conducted. Copy of this report issued

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

LIC809 (FAS) - (06/04)

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