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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610171
Report Date: 08/13/2024
Date Signed: 08/13/2024 03:28:05 PM

Document Has Been Signed on 08/13/2024 03:28 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:HEART TO HEART SENIOR LIVINGFACILITY NUMBER:
197610171
ADMINISTRATOR/
DIRECTOR:		VERONIKA YEBEYANFACILITY TYPE:
740
ADDRESS:9330 ALDEA AVETELEPHONE:
(747) 202-0923
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 6CENSUS: 3DATE:
08/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:55 AM
MET WITH:Veronika Yebeyan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 08/13/24 at 11:55 AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with Caregiver-Armine Hayrapetyan and disclosed the purpose of the visit. The Administrator-Veronika Yebeyan was called and arrived at 12:05 PM.

LPA asked for the census, resident, and staff files.


A physical tour was conducted at 1:05 PM and observed the following:



The Kitchen area was toured, and LPA observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. The fire extinguisher is located against the wall on your left-hand side, next to the sink. It is fully charged with dated 10/2024. There is a telephone line on one of the counters in the kitchen. There is extra, food emergency kits in the kitchen and in the kitchen pantry. The sharps are locked and inaccessible to the residents in one(1) of the upper cabinets of the kitchen on your right hand side. The medication is also locked and inaccessible to the residents in one (1) of the upper cabinets closer to where the kitchen table is located.

Outside/Backyard: The outside/backyard has furniture for residents with proper seating. The facility has a signal system. The facility has a pool that is fenced and locked that inaccessible to residents.

LIC 809C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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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: HEART TO HEART SENIOR LIVING
FACILITY NUMBER: 197610171
VISIT DATE: 08/13/2024
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Bedrooms: There are six (6) bedrooms. Two (2) bedrooms have private bathrooms and single occupied. The other four (4) bedrooms are also single, occupied with no bathroom. All bedrooms and bathrooms were toured and were properly furnished and have appropriate bedding, linens, toiletry and lightning. There are two (2) other bathrooms for resident and staff use. The bathrooms have proper toiletry and grab bars. The bathroom temperatures of the water are within regulations reading at 112-degree Fahrenheit.

The dining area/living room area is located next to the kitchen where there is enough seating for the residents and the staff. There is a large television and there is also internet access.



There is a separate area for the laundry. The washer, dryer and toxins are in the right side of the facility towards the back in a large cabinet. There is also extra linen kept in this area.

The carbon monoxide and fire alarms are located throughout the facility and are operable and interconnected.

Administrative: There an annual fee of 495.00 due by 09/07/24. At the entrance of the facility there is COVID signs, resident roster, YES signs, LGBT, Emergency Response, house rules, facility sketch, Infection Control, Mitigation Plan and Hospice Approval form against the wall. The insurance plan is updated and is dated 01/23/2024-01/23/2025.


An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC809 (FAS) - (06/04)
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