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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609895
Report Date: 09/22/2022
Date Signed: 09/22/2022 12:06:19 PM

Document Has Been Signed on 09/22/2022 12:06 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:SUN VALLEY CARE COTTAGE LLCFACILITY NUMBER:
197609895
ADMINISTRATOR:BAGHDASSARIAN, FLORIDAFACILITY TYPE:
740
ADDRESS:8553 GLENCREST DRIVETELEPHONE:
(818) 785-2344
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 6CENSUS: 0DATE:
09/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Florida BaghdassarianTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness met with Licensee Florida Baghdassarian and caregiver Amelia Hovakemian who were informed the reason of the visit. The facility currently has no residents, and has not admitted anyone since the beginning of the pandemic. LPA conducted a physical plant inspection and discussed mitigation measures, so that once they begin admitting residents, the facility is ready and have a plan in place.

The facility is in the process of marketing and ready to admit resident. There is currently no observed hand sanitizing station, and PPE located at the front door. But Licensee was made aware, that once the facility begins to admit residents, COVID-19 postings and hand-washing signs must be posted. Facility has thermometer, masks, hand sanitizer, and other PPE supplies available.

The infection control inspection was conducted throughout the facility. The facility has (3) bedrooms and (2) bathrooms. Currently, there is only (1) room ready, that has beds (6) feet apart. All common areas were observed to be clean, including bathrooms, that had soap and towels. There were no hand, washing signs observed; but Administrator have signs available, but informed LPA they will install once they begin admitting.



LPA conducted a mitigation plan review with the Administrator, to obtain information on how the facility has implemented the plan. Daily temperature for residents will be performed daily. Administrator informed LPA, she does receive the PINs from the department. Licensee will have to implement and make changes for designated rooms for potential positive COVID residents. PPE, chemicals, cleaning supplies, and paper products are stored in cabinets.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUN VALLEY CARE COTTAGE LLC
FACILITY NUMBER: 197609895
VISIT DATE: 09/22/2022
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Licensee prefers that all new hires/employees and residents be vaccinated before entering the facility. Currently, the facility is in the process of hiring new staff.

The facility is aware to report any changes with residents and staff to Licensing and there LPA, pertaining to positive COVID-19 cases.

Exit interview and copy of report provided.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC809 (FAS) - (06/04)
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