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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610152
Report Date: 10/19/2021
Date Signed: 10/19/2021 10:39:02 AM

Document Has Been Signed on 10/19/2021 10:39 AM - 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:
(747) 265-6536
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 6CENSUS: DATE:
10/19/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Marine GrigoryanTIME COMPLETED:
10:45 AM
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At 9:01 AM on 10/19/2021, Licensing Program Analysts (LPAs) Nicholas Reed and Tuesday Cabinness and Fire Inspector Linsay Pellegrini met with Administrator Marine Grigoryan for an announced Case Management visit. Administrator intended to show the recommended modifications since the recent Prelicensing visit on 09/30/2021. LPAs and Fire Inspector toured the facility inside and out and inside the Additional Dwelling Unit (ADU). LPAs observed the changes made throughout the facility. The open outlet between Bedrooms #3 and #4 was covered. LPAs observed 3 non-slip mats in the Bathroom adjacent to Bedroom #1, the bathroom nearest the kitchen, and the bathroom adjacent to Bedroom #4. LPAs also saw the microwave was mounted and installed in the kitchen. A black grate now covers the fireplace opening. LPAs observed a sufficiently large Personal Rights poster, an Emergency Exit posting, and instructions for residents to issue confidential complaints posted at the front door. LPA Reed observed 4 nightlights in the facility. They were present in a bathroom, a bedroom, and the hall. Administrator showed LPA Reed the new First Aid kit with tweezers, scissors, thermometer, and a manual. LPAs observed a toilet paper rack in Bathroom adjacent to Bedroom #1. LPAs also observed a bed set up in Bedroom #1 with sheets, blankets, linens, and pillows.

Administrator showed the new facility sketch designating an Additional Dwelling Unit (ADU) with a separate address of 18837 West Lemay Street, Reseda CA 91335. LPA Reed will submit this new sketch to the Central Applications Bureau. LPAs observed a Certificate of Occupancy for the ADU and took a photo.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2021
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: 10/19/2021
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---- This is an amended report to remove confidential information ----

LPA Reed advised Administrator to submit a new STD 850. Administrator will submit a new STD 850 to LPA Reed via email.

ADU inspection: LPAs observed black address numbers posted on ADU reading 18837. LPAs toured inside the ADU and observed a kitchen, bathroom, a bedroom and living room. LPAs observed zero residents inside. Administrator told LPAs the ADU is inhabited by Marine Grigoryan and S1 who are fingerprint cleared and associated with Palace of Joy, Inc. LPA Reed told both Marine and S1 that anyone intending to live in the ADU must be fingerprint cleared and associated with Palace of Joy, Inc. prior to living there. This holds especially true if any form of rental agreement, with or without payment, is signed. Administrator asked if visitors may stay in the ADU temporarily. LPA Reed advised that if they are not fingerprint cleared and associated with Palace of Joy, Inc. they may not step foot outside or inside the facility.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2