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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609565
Report Date: 12/10/2024
Date Signed: 12/10/2024 02:59:54 PM

Document Has Been Signed on 12/10/2024 02:59 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:WHOLESOME LIFE SENIOR LIVINGFACILITY NUMBER:
197609565
ADMINISTRATOR/
DIRECTOR:
TASHCHYAN, ARPINEFACILITY TYPE:
740
ADDRESS:22040 COVELLO STTELEPHONE:
(310) 975-5452
CITY:CANOGA PARKSTATE: CAZIP CODE:
91303
CAPACITY: 6CENSUS: 6DATE:
12/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Barkev Tachchyan, Staff TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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At 12:00pm, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with the Administrator and explained the reason for the visit.

Facility is licensed for capacity of six (6) non-ambulatory residents, of which 1 may be bedridden, and has a hospice waivers for three (3). At 12:10pm, LPA toured the kitchen area and observed there to be sufficient stock of one-week perishable foods and two-day non-perishable foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. All sharps and knives were locked in a kitchen drawer. LPA observed a fire extinguisher in the kitchen was last serviced on 12/26/23. Laundry is located by the kitchen area and the washer/dryer appeared to be in good condition. All chemicals and detergents are kept locked and inaccessible to residents in care. 12:20pm LPA observed medications are centrally stored and locked in the cabinet, by the dining area and inaccessible to residents in care. There are six (6) bedrooms designated for residents’ use. All bedrooms are appropriately furnished and have appropriate lighting. Facility also has a room for a live-in staff. Bathrooms have soap, paper towels. Extra towels and linens were readily available. The hot water temperature measured at 120.0°F. The facility maintains a comfortable temperature at 77°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. At 12:40pm, LPA observed appropriate outdoor furniture, with a covered shaded area for residents. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. Smoke detectors and carbon monoxide were tested at 1:16pm and observed to be operational.
Between 1:20pm am to 2:50pm, LPA reviewed records of six (6) client and three (3) staff. Client and staff records appeared to be complete and updated. LPA collected Certificate of Liability Insurance and LIC500.
No deficiency cited during today's visit.
Exit interview conducted and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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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