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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609077
Report Date: 09/27/2021
Date Signed: 09/27/2021 12:47:30 PM

Document Has Been Signed on 09/27/2021 12:47 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:ALL ABOARD!FACILITY NUMBER:
197609077
ADMINISTRATOR:AVETISYAN, HEGHINEFACILITY TYPE:
740
ADDRESS:10629 COLLETT AVETELEPHONE:
(818) 636-8985
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 5DATE:
09/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Andranik Ter nersesian/ AdministratorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Patrick Shanahan, met with administrator Andranik Ter nersesian for Required One (1) Year visit for this facility. This was an infection control visit.

A tour of the physical plant was conducted with Mr. Ter-nersesian. The facility has four (4) bedrooms and two (2) bathrooms. There is also an office room located near the kitchen. One (1) bathroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents, of which one (1) may be bedridden and has a Hospice waiver for two (2) residents.

Upon entry, Facility staff took the LPA's temperature and had the LPA wash hands and sign in.

Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked.

Living and dining room furniture were also checked. The living room is neat and clean along with the dining room. The facility maintains a comfortable temperature at 75°F. The smoke detectors are hardwired and interconnected and observed to be operational. There is a carbon monoxide detector installed at the facility and equipped with fire sprinkler system. All doors are equipped with auditory alarm.

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

There is no garage at the facility only car ports in front of the house.

Exit interview conducted and report issued.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2021
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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