197609851-11-1-2024-29-AS-EMOY-DALRYS-20241101132649

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609851
Report Date: 11/01/2024
Date Signed: 11/01/2024 01:27:45 PM

Document Has Been Signed on 11/01/2024 01:27 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	VH CARE		FACILITY NUMBER:	197609851
ADMINISTRATOR/ DIRECTOR:	VAHAGN HARUTYUNYAN		FACILITY TYPE:	740
ADDRESS:	13945 SYLVAN STREET		TELEPHONE:	(818) 322-8838
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91401
CAPACITY: 6		CENSUS: 5	DATE:	11/01/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	VAHAGN HARUTYUNYAN- Administrator		TIME VISIT/ INSPECTION COMPLETED:	01:40 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) Erica Mosley arrived at the facility unannounced to conduct a required annual visit at 9:30 a.m. Upon arrival, there was one (1) staff and four (4) residents present. One (1) resident is currently at the hospital. Staff called Administrator and arrived shortly after. The LPA met with Administrator VAHAGN HARUTYUNYAN and explained the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA toured the kitchen/food service area at 9:50 a.m. The hot water was measured at 112.6 degrees Fahrenheit at 9:54 a.m. The kitchen appeared clean and the appliances and fixtures functional. Refrigerated and frozen foods were stored at proper temperature. There was a sufficient amount of two (2) day perishable and seven (7) day non-perishable food. Food labels were inspected and checked for dates and expiration dates. Food had labels clearly marked with dates. Knives and sharps were observed locked in a cabinet. Cleaning supplies were stored under the kitchen sink locked and inaccessible. There were no pesticides or poisons observed near any food areas. Page 1 (Report Continued on LIC 809C... 2nd Page)

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VH CARE	FACILITY NUMBER: 197609851
	VISIT DATE: 11/01/2024

NARRATIVE

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(Report Continued from LIC 809...Page 1)..... 2nd page
LIVING ROOM/DINING ROOM: The LPA inspected the living room and dining room area. The common areas were observed to be properly furnished and clean at the time of the visit. Furniture was observed to be in good condition. Fireplace was observed to be adequately screened at the time of the visit. The facility maintained a comfortable temperature. At 10:33 a.m., the smoke detector(s) and carbon monoxide detectors were tested and operational. Fire extinguishers were observed fully charged and purchased on 03/18/24. The LPA observed required postings throughout the common spaces. The facility has a working telephone on premises. Auditory alarms on all doors were functional at the time of the visit. Entry/exits were free of obstruction. There is a washer and dryer on the premises. The last emergency disaster drill took place on 10/12/2024 and are conducted quarterly. Activities were observed in the common areas.
GARAGE/OUTDOORS: There is a garage that is kept locked and inaccessible at all times. There was another refrigerator observed with additional food. An adequate supply of emergency food and water was observed. The LPA observed a sufficient supply of Personal Protectant Equipment (PPE). Cleaning supplies and toxins were observed in the garage inaccessible to residents in care. The backyard has a shaded area with furniture for resident use. The LPA observed one gate that self-latches with a clear passageway in case of an emergency. There were no bodies of water noted at the time of the visit.
BEDROOMS: There are (3) shared resident bedrooms. The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets.
BATHROOMS: There are two (2) bathrooms one (1) for resident use and one (1) for staff which remains locked but can be used in an emergency. Resident bathroom was clean and sanitary and in operating condition with grab bars and non-skid surfaces. The hot water was measured at 110.7 degrees Fahrenheit within the required range.

(Report Continued on LIC 809C... 3rd page)

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VH CARE	FACILITY NUMBER: 197609851
	VISIT DATE: 11/01/2024

NARRATIVE

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(Report Continued from LIC 809C...2nd Page) 3rd Page

RECORDS: Records review began at 10:43 a.m., five (5) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. All files were in order at this time. Four (4) Personnel records and Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order.

MEDICATIONS: Medications review for five (5) residents began at approximately 12: 45 p.m. Medications are centrally stored in a cabinet by the kitchen locked and inaccessible to residents in care. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. No medication errors observed at this time.

The LPA interviewed one (1) staff, and two (2) residents during the inspection.

During today’s visit, the LPA obtained copies of the following: LIC 500 Personnel Report, LIC 9020 Resident Roster, and current liability insurance.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

LIC809 (FAS) - (06/04)

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