<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609655
Report Date: 03/18/2025
Date Signed: 03/18/2025 05:14:58 PM

Document Has Been Signed on 03/18/2025 05:14 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:TNA RESIDENTIAL CAREFACILITY NUMBER:
197609655
ADMINISTRATOR/
DIRECTOR:		AKMAKCHYAN, MARIFACILITY TYPE:
740
ADDRESS:18627 LANARK STREETTELEPHONE:
(818) 593-9292
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 6CENSUS: 5DATE:
03/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Mari Akmakchyan, StaffTIME VISIT/
INSPECTION COMPLETED:
04:20 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
At 12:30 PM, Licensing Program Analysts (LPAs), Huma Rahimi, and Angela Panushkina, conducted an unannounced annual inspection at the facility mentioned above. LPAs were greeted by the staff, Mari Akmakchyan, who granted access to the facility. LPAs explained the reason for the visit.

This facility is licensed for the capacity of six (6) Ambulatory residents.

Upon arrival, Mrs. Akmakchyan informed LPAs that the facility currently has five (5) residents, of which two (2) are bedridden and three (3) are ambulatory. LPAs were also informed that none of the residents are on Hospice.

At approximately, 12:35 PM, LPAs conducted a tour of the facility, and the following was observed:

Common Areas: The facility maintains a comfortable temperature at 73°F. The living room and dining area appeared clean and were properly furnished. No obstructions observed throughout the facility. The facility license was not posted and or available for review.

Kitchen: LPAs observed sufficient supplies of staple non-perishable for 1 week and perishable for 2 days. At 10:15am, LPAs observed resident medications/injectable in the refrigerator unlocked. All knives and other sharps were observed locked in the kitchen drawer. LPAs observed all other medication locked in the kitchen cabinet. There is a fire extinguisher by the kitchen that was last purchased on 10/1/2024.

Bedrooms: There are three (3) bedrooms designated for residents use and have sufficient lighting. All bedrooms have appropriate bedding and linens. LPAs observed two (2) half rail beds in room #1 and room #2, without Physician order. Physician's order for half bed rails were not available upon request. Moreover, LPAs observed a television stand that was blocking the emergency exit door.

Continue on LIC 809C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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: TNA RESIDENTIAL CARE
FACILITY NUMBER: 197609655
VISIT DATE: 03/18/2025
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
26
27
28
29
30
31
32
Bathrooms: LPAs observed two (2) bathrooms for resident use and both appeared to be clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPAs observed appropriate grab bar and resident's bathroom had non-skid mat. LPAs observed appropriate hand washing signs posted in each bathroom.

Outside areas: At approximately, 12:50 PM, LPAs toured the outside area of the facility. LPAs observed a clean covered patio and backyard furniture to accommodate the six (6) residents.

Laundry: Laundry room is located outside and during the walk though, LPAs observed the room locked and inaccessible to residents in care.

Resident Files: At 11:00am LPAs conducted resident and staff records review. The following was observed. two (2) out of five (5) resident files were incomplete. Files were missing Admission Agreement, Resident Preplacement, Appraisals/Reappraisal, List of personal property, ID Emergency Sheets, and Personal Rights. Please see LIC858 included with this report.

Staff Files: The following was observed. The Administrator has not renewed her Administrators Certificate since 08-26-2020, and the facility is currently have no active Administrator on file. LPAs conducted review of Licensing Information System and did not observe Staff #1(S1) being associated with the facility. S1's fingerprints determination on a guardian was: " Not Eligible. Determination Closed."

Medications review: At approximately, 3:00pm LPAs conducted a review of medication for residents in care. All records were observed to be complete and updated.

Administrative: . LPAs collected a copy of Liability Insurance and LIC500.

Deficiencies and civil penalty issued, see LIC809Ds.

Exit interview conducted, appeal rights explained and copy of report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 03/18/2025 05:15 PM - It Cannot Be Edited


Created By: Huma Rahimi On 03/18/2025 at 03:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TNA RESIDENTIAL CARE
FACILITY NUMBER: 197609655

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87202(a)(2)
Fire Clearance: (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above by accepting two bedridden residents (R1 & R2) without having a proper fire clearance, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/20/2025
Plan of Correction
1
2
3
4
Licensee must submit LIC200 along with the facility sketch by POC date.

Immediate civil penalty will be assessed.
Type A
Section Cited
CCR
87705(f)(2)
Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above, R2's injection medication was placed in a refrigerator unlocked and accessible to residents in care, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/20/2025
Plan of Correction
1
2
3
4
Licensee agreed to conduct an in-house training with all staff regarding the care for Dementia residents and always keep medications and locked. Proof of training will be emailed to LPA by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nichelle Gillyard
LICENSING EVALUATOR NAME:Huma Rahimi
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2025


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 03/18/2025 05:15 PM - It Cannot Be Edited


Created By: Huma Rahimi On 03/18/2025 at 03:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TNA RESIDENTIAL CARE
FACILITY NUMBER: 197609655

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87608(a)(3)
Postural Supports: Based on the individual pre-admission appraisal and subsequent changes to that appraisal the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for him/herself. Postural support may be used under the following condition: 3) A written order from the Physician indication the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.
This requirement is not met as evidenced by:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above. Two (2) out of five (5) residents have a half bed rail without a doctor's order, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/25/2025
Plan of Correction
1
2
3
4
Licensee agreed to obtain a doctor order for ttwo (2) half bed rails. Copy of proof will be submit it to LPA
Type B
Section Cited
CCR
87406(g)
Administrator Certification Requirements: (g) Certificates issued under this section shall be renewed every two (2) years provided the certificate holder has complied with all renewal requirements.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above. Faciity's Administrator certificate had been expired since August 2020, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/25/2025
Plan of Correction
1
2
3
4
Licensee agreed to renew the Administrator certificate and submit proof of enrolled classe to LPA by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nichelle Gillyard
LICENSING EVALUATOR NAME:Huma Rahimi
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2025


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 03/18/2025 05:15 PM - It Cannot Be Edited


Created By: Huma Rahimi On 03/18/2025 at 03:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TNA RESIDENTIAL CARE
FACILITY NUMBER: 197609655

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87355(e)(1)
Criminal record clearance: (e) All individuals subject to a criminal record review... (1) Obtain a California clearance or a criminal record exemption as required by the Department.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above by hiring one (1) staff member S1 on March 14th, 2025 without fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/20/2025
Plan of Correction
1
2
3
4
Licensee agreed to complete S1's fingerprints and associate the staff to the facility. Copy of proof will be submitted to LPA by POC date.

Civil penalty assessed.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nichelle Gillyard
LICENSING EVALUATOR NAME:Huma Rahimi
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2025


LIC809 (FAS) - (06/04)
Page: 5 of 5