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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610014
Report Date: 10/15/2024
Date Signed: 10/15/2024 02:23:50 PM

Document Has Been Signed on 10/15/2024 02:23 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:RITE CARE ASSISTED LIVING CHFACILITY NUMBER:
197610014
ADMINISTRATOR/
DIRECTOR:		MAMYAN, NARINEFACILITY TYPE:
740
ADDRESS:829 N. CRESCENT HEIGHTS BLVD.TELEPHONE:
(818) 433-5622
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY: 6CENSUS: 6DATE:
10/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:26 AM
MET WITH:Narine MamyanTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 10/15/24, at 10:28am, Licensing Program Analyst, (LPA) Raymond Comer, arrived to conduct an unannounced annual visit of the facility. LPA met with Facility Administrator, Narine Mamyan, and reason for the visit was disclosed.

Facility is licensed as a single-story residence; fire clearance is licensed for six (6) non-ambulatory residents; ages 60 and older. Two (2) residents may be bedridden; hospice waiver is for four (4) residents. Facility has four (4) bedrooms, and two (2) bathrooms.

At 10:45am, LPA conducted a tour of the physical plant with the Administrator, and observed the following:

Physical plant was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access point. Emergency exits are at the rear of the living room area, and at each bedroom.
Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Covid 19 prevention protocols are posted. Hand washing, coughing etiquette, and other necessary signage is posted throughout the facility. Room temperature is comfortable; wall thermostat displays a setting of 73.0°F; within the required range.
Required postings are prominently displayed and observed to be current. Disaster drills were last conducted on 7/22/2024.

Fire Detection system is present. Dual smoke-carbon monoxide detectors are located throughout the facility. Detectors were tested and function properly. LPA observed one fire extinguisher hanging on the wall in the kitchen area; last service date was 7/15/24.

[LIC 809C-Continued]

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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 3
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: RITE CARE ASSISTED LIVING CH
FACILITY NUMBER: 197610014
VISIT DATE: 10/15/2024
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Kitchen: At 11:25 am, LPA observed kitchen as clean, equipped with a functional stove, multiple appliances, with an adequate supply of perishable and non-perishable foods. Emergency food is stored and locked in pantry cabinets near the kitchen area. Food is observed as properly labeled and stored. Kitchen cabinets contain dishes, plastic, paper goods and utensils. Knives and sharps are stored and locked in kitchen drawer, inaccessible to residents.

Medications were observed as stored in a living room storage closet; area was found locked and inaccessible to residents. Facility has fully stocked first aid kit and manual located and in the medication area. Medications are listed on a centrally stored medication and destruction record log.

Laundry: LPA observed the laundry room located in storage room across from the kitchen area. Laundry machines, soaps, and other cleaning agents are secured and inaccessible for residents. Linen storage observed to have adequate supply of linen and towels.

Garage: There is no garage at the facility only a drive way in the front yard.

Commons: LPA observed all common areas of the facility, including the resident dining area. LPA observed common areas to be clean, organized, properly furnished and in excellent condition. Facility is furnished with piano, television, reading materials, and board games for residents use.

Bedrooms are observed as clean, with sufficient lighting, properly furnished with bedding, linens, and at least one chair, and night stand.

Bathrooms were observed to be clean and sanitary with necessary supplies, and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 113.0°F. Within the required range.

Outdoor (backyard) area observed to have a shaded patio, with table with sufficient seating for the residents. Outdoor furniture observed to be in good condition. A storage shed in the backyard contains PPE and incontinent products for residents; this shed was observed to be locked during the visit. Outdoor area observed as clean and clear from obstruction. No bodies of water are located on the premises.

Resident records: A total of six (6) resident files were reviewed for current IPP and/or Needs and Services plans, physician report, and admission agreements. Resident records appeared to be complete and current.

[LIC 809C-Continued]

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: RITE CARE ASSISTED LIVING CH
FACILITY NUMBER: 197610014
VISIT DATE: 10/15/2024
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Staff records: A total of five (5) Staff files were reviewed. Criminal record clearances were present. Staff are associated to this facility. Staff records appear to be complete and current.

There were no immediate health and safety hazards observed at the time of this inspection. Exit interview conducted and a copy of this report was provided to the Administrator.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC809 (FAS) - (06/04)
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