197609357-2-5-2025-31-AS-NSHN-DDM3FH-20250205171245

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609357
Report Date: 02/05/2025
Date Signed: 02/05/2025 05:13:04 PM

Document Has Been Signed on 02/05/2025 05:13 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:	BIRMINGHAM VILLA		FACILITY NUMBER:	197609357
ADMINISTRATOR/ DIRECTOR:	LEKHLYAN, ANAHIT		FACILITY TYPE:	740
ADDRESS:	825 BIRMINGHAM RD		TELEPHONE:	(818) 859-7777
CITY:	BURBANK	STATE: CA	ZIP CODE:	91504
CAPACITY: 6		CENSUS: 5	DATE:	02/05/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:15 AM
MET WITH:	Christine Lekhlyan - Administrator		TIME VISIT/ INSPECTION COMPLETED:	04:30 PM

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Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced Annual Required visit and inspection of the facility. Upon arrival at 10:15 am, LPA met with Administrator/Christine Lekhlyan. LPA asked for copies of staff and resident rosters and files. The purpose of the visit was explained. The facility is licensed to serve 6 (six) non-ambulatory residents with hospice waiver for three (3) residents. Current census is five (5) and all five (5) residents receive services from the Frank D. Lanterman Regional Center.

At 10:45 am, with the assistance of Administrator, Christine Lekhlyan, LPA toured the physical plant area inside and outside to ensure there are no health and safety hazards. The walls, floors and general area was in good repair with good lighting. Mandated postings were observed in the office area and were readily available for review. Smoke alarms and carbon monoxide detectors were tested to be functioning properly. There were two (2) fire extinguishers, both purchased on 01/16/2025, one in the kitchen and one in the dining area. Facility conducts monthly fire drills and LPA was provided a log of all the drills. The last fire drill was conducted on 01/12/2025. There are four (4) exits, the main entry door, one in bedroom five (5), one in the kitchen and the main fire exit is in the living room. All exits were equipped with functional alarms.

The following was observed:

Structure: The facility is a single story house located in a residential area. The house has seven (7) bedrooms, one (1) staff room and six (6) private resident bedrooms, two (2) full bathrooms for residents and a half bathroom for staff. There is a kitchen, living room, dining room. Laundry machines are located in the office area with chemicals and detergents locked in a hallway closet.

Cont. in 809-C

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BIRMINGHAM VILLA	FACILITY NUMBER: 197609357
	VISIT DATE: 02/05/2025

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Common Areas: These included separate living room and dining area. The common areas were properly furnished. LPA observed ample chairs/sitting for six (6) residents and staff. There is an non-functional screened fire place in the dining room. LPA observed a gaming area, with a small refrigerator and a freezer in the dining room. Living room has sofas, table and a television set.

Surrounding Grounds: Entry/exits passageways were free of obstruction. There is a side yard with covered patio, with appropriate furniture for outdoor use with ample seating for six (6) residents. The outdoor area was free of hazards; no body of water observed. The main exit door was observed to be unlocked from inside.

Kitchen: The kitchen is equipped with a refrigerator, stove/oven, dishwasher, microwave. All appliances and fixtures were observed to be clean and in functional condition. LPA found sufficient amount of perishable and non-perishable food, sufficient for all six (6) residents for at least 10 days. Knives and sharp objects were stored in a locked drawer in the kitchen. Properly labeled medications were locked the kitchen cabinets. There were two (2) First Aid Kits with First Aid Manual, one locked in kitchen cabinet and the other in hallway closet. The kitchen cabinets were observed to have ample dishes and cook ware.

Bathrooms: There are two (2) bathrooms designated for residents' use and a half bath for staff. Both resident bathrooms were sanitary and had the required grab bars and non-skid mats and functional fixtures. Hot water temperature was measured at 106.8 degrees Fahrenheit.

Bedrooms: There were six (6) private bedrooms designated for residents' use and one (1) for night staff. All bedrooms in use by residents were properly furnished with appropriate beddings and linens with sufficient lighting. Each room was equipped with chairs, cabinets and extra bedding.

Cont in 809-C

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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: BIRMINGHAM VILLA	FACILITY NUMBER: 197609357
	VISIT DATE: 02/05/2025

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The medication, chemicals and first aid are locked and secured in the kitchen cabinet. There is also a first aid manual and two (2) First Aid Kits with scissors, tweezers and supplies, one in the kitchen and the other in the hallway closet.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training certificates are up to date and compliance with licensing forms.

Medications: Medication and Medication Records were reviewed for proper documentation. LPA counted the medications and ensured proper dosage were
given to residents.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit.

Exit Interview Conducted / A Copy of the Report provided to Administrator, Lekhlyan.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC809 (FAS) - (06/04)

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