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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610152
Report Date: 09/30/2021
Date Signed: 09/30/2021 04:25:44 PM

Document Has Been Signed on 09/30/2021 04:25 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:PALACE OF JOYFACILITY NUMBER:
197610152
ADMINISTRATOR:GRIGORYAN, MARINEFACILITY TYPE:
740
ADDRESS:6701 KURL WAYTELEPHONE:
(310) 779-4433
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 6CENSUS: DATE:
09/30/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Administrator Marine GrigoryanTIME COMPLETED:
04:30 PM
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Licensing Program Analysts (LPA) Nicholas Reed and Tuesday Cabinness arrived to Palace of Joy (#197610152) at 1:10PM on 09/30/2021 and met with Administrator Marine Grigoryan for an announced Pre-Licensing Inspection. LPAs toured the physical plant inside and out. LPAs observed medications locked in a separate storage area. LPAs observed the walls, wallpaper, paint, and ceiling in good condition. LPAs observed windows and blinds in operating condition, yet not all windows had screens. LPAs advised to put screens on all windows. LPAs observed clean floors with no rugs. LPAs observed all doors as operational, yet LPAs told Administrator to replace screen on the screen door in the dining room. LPAs observed equipment and supplies stored away from common areas. LPAs saw smoke detectors functioning properly and fire extinguisher is fully charged. LPAs observed furniture in good repair and cleaning supplies and hazardous items locked outdoors. LPAs observed no firearms nor ammunition. LPAs tested handrails which were securely fastened. LPAs noticed hallways and doors were unobstructed. LPAs observed no immediate hazards on the premises. LPAs observed unobstructed hallways. LPAs observed a hole in the wall which needs covering. LPAs sensed all rooms were odorless. LPAs sensed room temperatures between 68 and 85 degrees. LPAs observed a locked gate and fence around the pool. LPAs observed no flies or vermin in the facility. LPAs observed an adequate number of bedrooms present to accommodate residents. LPAs observed secure and non-slippery ramps. LPAs noticed incongruences among the facility sketch and the physical plant, so LPAs requested Administrator submit a new facility sketch.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2021
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: PALACE OF JOY
FACILITY NUMBER: 197610152
VISIT DATE: 09/30/2021
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LPAs observed adequate closet space and drawers in bedrooms, along with sheets, pillows, pillow cases, blankets, and mattress pads. However, only 2 beds were set up in bedroom #2 and in no other bedrooms. LPAs advised Administrator to set up mattresses, beddings, and arrangements prior to residents’ arrival. LPAs toured bathrooms and observed clean toilets, sinks and showers. LPAs required Administrator put non-slip mats in the showers and tubs. LPAs observed sinks operating properly, secure grab bars, and a sufficient supply of towels and wash cloths. LPAs saw ample supplies of personal hygiene and linens for residents. LPAs observed the kitchen to be free of cleaning supplies and pesticides. LPAs observed non-perishable food supply adequate for less than one week and no perishable food. LPAs advised Administrator to increase food supply. LPAs observed a lid on a large trash can, and two trash cans in a drawer. LPAs also observed clean and plenty of plates, cups, bowls, and utensils. LPAs observed a microwave which was not installed, and a vent hole which was open. Administrator stated that the microwave will be installed soon and hole will be covered. LPAs observed a confidential file cabinet. LPAs observed postings for personal rights on the wall, but LPAs did not observe Emergency Exit route or procedures for filing complaints. LPAs told Administrator to post Emergency Exit plans throughout the house, as well as a procedure for filing confidential complaints. LPAs observed activity supplies and card games. LPAs reviewed the outdoor activity area for residents and determined it must be revised. LPA Reed will consult on fencing requirements between garage and main facility. LPAs observed dressings and bandages in a First Aid Kit, but LPAs did not see tweezers, thermometer, scissors, nor first aid manual. LPAs requested Administrator complete the first aid kit with the aforementioned items. LPAs observed washer and dryer near the kitchen. LPAs noted a working telephone. LPAs noted emergency flashlights and batteries but did not see night lights in outlets. LPAs recommended putting night lights in all rooms and hallways. Facility does not have vehicle for residents. LPA Cabinness completed Component III with Administrator.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
LIC809 (FAS) - (06/04)
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