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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610237
Report Date: 02/27/2025
Date Signed: 02/27/2025 03:06:06 PM

Document Has Been Signed on 02/27/2025 03:06 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:ABAD CARE HOMESFACILITY NUMBER:
197610237
ADMINISTRATOR/
DIRECTOR:		OLIVAS, MYLINEFACILITY TYPE:
740
ADDRESS:20128 DEVONSHIRE STTELEPHONE:
(747) 237-0417
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 6CENSUS: 4DATE:
02/27/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Myline Olivas, Administrator TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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At 1:10pm Licensing Program Analysts (LPAs), Angela Panushkina and Perchui Milena Khurshudyan, conducted an unannounced annual inspection at the facility mentioned above. LPAs were greeted by Staff #1 (S1), who granted access to the facility. Administrator arrived shortly after, and LPAs explained the reason for the visit.

At approximately, 1:15pm LPA Panushkina and S1 conducted a physical tour the following observed:

Common Areas: The facility maintains a comfortable temperature at 74°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility.

Kitchen: At approximately, 1:20pm LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to residents. There is a fire extinguisher was last serviced on 07/24/2024.

Medications: At approximately, 1:25pm LPA observed medications are centrally stored and locked in the cabinet, by the kitchen area and inaccessible to residents in care.



Bedrooms: There are four (4) bedrooms designated for residents use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms were tested and observed to be operational. Facility has awake staff.

Bathrooms: At 1:30pm LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 115.8°F. LPA observed appropriate grab bar and had non-skid mat. All trash cans in bathrooms had fitted lids to protect from cross contamination. Continue on LIC809-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
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: ABAD CARE HOMES
FACILITY NUMBER: 197610237
VISIT DATE: 02/27/2025
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Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 1:35pm they were tested and observed to be operational.

Outside areas: At approximately, 1:40pm LPA toured the outside area of the facility and 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.



Between 1:45pm to 2:40pm, LPAs reviewed records of four (4) residents and three (3) staff. Resident and staff records appeared to be complete and updated.

Administrative: Annual fee is current. All required signs are posted. LPA collected LIC500, Certificate of Liability Insurance and Administrator Certificate.

No citations issued during this visit.

Exit interview conducted. Copy of report emailed to Licensee.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC809 (FAS) - (06/04)
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