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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610159
Report Date: 03/05/2025
Date Signed: 03/05/2025 11:41:11 AM

Document Has Been Signed on 03/05/2025 11:41 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:CHATSWORTH LIVINGFACILITY NUMBER:
197610159
ADMINISTRATOR/
DIRECTOR:		TOUPHANIAN, ABRAHAMFACILITY TYPE:
740
ADDRESS:20453 MAYALL STREETTELEPHONE:
(818) 590-6793
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 6CENSUS: 4DATE:
03/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Abraham Touphanian, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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At 9:30am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with the Staff #1 who granted access to the facility. Administrator arrived shortly after and LPA explained the reason for the visit.

At 9:35am LPA conducted a tour of the physical plant and observed the following:

Facility is licensed for capacity of six (6) Non-Ambulatory residents and one (1) bedridden (in room #1 or #2). There are four (4) bedrooms designated for resident's’ use, of which two (2) bedrooms are private and two (2) bedrooms are shared. Bedrooms are appropriately furnished and have appropriate lighting. Facility has awake staff at night. Bathrooms have soap, paper towels and hand washing signs were observed. Extra towels and linens were readily available. The hot water temperature measured at 114.2°F. Facility maintains a temperature of 70°F. LPA 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 knives were observed to be locked in the kitchen drawer. The fire extinguisher is located in the dining area and was last serviced on 10/04/2024. Medications and resident/staff files are kept in a metal cabinet, located in the dining area and kept locked and inaccessible to residents' in care. Laundry is located in the garage. The washer/dryer appear to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. All chemicals, detergents and medications are kept in the garage and inaccessible to residents in care. Smoke detectors and carbon monoxide monitors were tested at 10:00am and observed to be functional. At 10:20am, 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. There are no bodies of water.
Continue on LIC809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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: CHATSWORTH LIVING
FACILITY NUMBER: 197610159
VISIT DATE: 03/05/2025
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Dual smoke and carbon monoxide detectors were located throughout the facility, and at 10:30am they were tested and observed to be operational.

Between 10:50am to 11:30am, LPA reviewed records of four (4) residents and two (2) staff. Resident and staff records appeared to be complete and updated. LPA collected Certificate of Liability Insurance, Administrator Certificate and LIC500.



No citations issued during this 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: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC809 (FAS) - (06/04)
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