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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609909
Report Date: 11/14/2024
Date Signed: 11/14/2024 02:22:19 PM

Document Has Been Signed on 11/14/2024 02:22 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:SKY LIGHT RESIDENTIAL CAREFACILITY NUMBER:
197609909
ADMINISTRATOR/
DIRECTOR:
PODRUMYAN, MAROFACILITY TYPE:
740
ADDRESS:19856 MAYALL STREETTELEPHONE:
(818) 945-8301
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 6CENSUS: 6DATE:
11/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:25 PM
MET WITH:Maro Podrumyan, Administrator TIME VISIT/
INSPECTION COMPLETED:
02:50 PM
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At 12:20pm, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with the Staff #1 (S1) who granted access to the facility. Administrator arrived shortly after and LPA explained the reason for the visit.

Facility is licensed for capacity of six (6) Bedridden residents. Hospice waiver for six (6) residents was approved on February 5th, 2024. At 12:30pm, 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 appropriately. Food storage and preparation areas are clean and inaccessible to pests. All sharps and knives were locked in a kitchen drawer. The facility has two (2) fire extinguishers located throughout the facility and were observed to be full. 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. Medications were stored in a locked, hallway closet. There are five (5) bedrooms designated for clients’ 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 and hand washing signs were observed. Extra towels and linens were readily available. The hot water temperature measured at 120.0°F. Facility maintains a temperature of 70°F. Smoke detectors and carbon monoxide monitors were tested at 1:30pm and observed to be functional. 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.

Between 1:00pm am to 2:00pm, LPA reviewed records of six (6) client and two (2) 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: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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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