197610268-7-5-2022-31-AS-TCAS-CG2NNJ-20220705103649

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610268
Report Date: 07/05/2022
Date Signed: 07/05/2022 10:37:54 AM

Document Has Been Signed on 07/05/2022 10:37 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:	BEST CHOICE SENIOR CARE		FACILITY NUMBER:	197610268
ADMINISTRATOR:	ALEXANDRYAN, DANIEL		FACILITY TYPE:	740
ADDRESS:	11159 COHASSET STREET		TELEPHONE:	(818) 433-1682
CITY:	SUN VALLEY	STATE: CA	ZIP CODE:	91352
CAPACITY: 6		CENSUS: 0	DATE:	07/05/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Daniel Alexandryan		TIME COMPLETED:	10:45 AM

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Licensing Program Analyst (LPA) Tuesday Cabiness conducted a PRE-LICENSING visit to the above address 11159 Cohasset, Sun Valley, CA 91352. LPA met with Administrator Daniel Alexandryan. The inspection included, fire safety, personal accommodations, building and grounds, furniture/equipment, food service, and medication procedures. Fire Inspection was approved on March 03, 2022 which met fire department requirements for (3) shared rooms, which all rooms could have non-ambulatory residents; room # 3, is only allowed for (1) bedridden resident, which includes an exit door. Facility is pending approval for (6) hospice residents; dementia waiver has not been decided at this time. Facility sketch, emergency disaster plan, complaint procedures, personal rights, emergency exit plan, and other required Licensing were visibly posted. COVID signs, visitor book, and hand washing station observed at the front entrance.

The physical plant was toured inside and out with Administrator Daniel. The facility is a one level home, with (3) shared bedrooms with (2) bathrooms; there is no staff room or office. Food supply was inspected and observed, and storage areas, cabinets, pantries, cupboards counters, and refrigerator were clean and appropriate for food preparation. Knives and medication were stored in cabinets located in the kitchen area. Appliances were clean and functional, and utensils, plates, and cups were in good repair. Cleaning supplies, poisons, toxins and chemicals were locked and stored in the laundry and pantry room. There was enough supply of linens and towels, which were stored in a cabinet located in the hallway. Hygiene products were also available, which were locked and secured. LPA observed at least (30) day supply of PPE.

The common areas included the dining, living, bathroom, and bedrooms. Doors and passageways were clear and unobstructed. Walls, ceilings, floors, window screens and all other rooms were clean, in good repair, and appropriately furnished. Resident rooms

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

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: BEST CHOICE SENIOR CARE	FACILITY NUMBER: 197610268
	VISIT DATE: 07/05/2022

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observed to have a mattress with pad, sheets, pillow, bedspread, dresser, closet space, and chair. Bathrooms were clean had functional fixtures, with soap and towels, non-skid mats, grab bars and hand washing signs were posted. The water temperature measured at 105.8 degrees Fahrenheit. The back yard is completely fenced with a gate easily accessible and unlocked. There are no swimming pools or other bodies of water, no visible hazards around the surrounding grounds. Patio furniture with covering available for resident's use.

Smoke detectors and carbon monoxide were hardwired and operating correctly. Fire extinguisher is fully charged. Telephone installation was completed. First aid kit inspected. Staff and client files will be stored and locked in a cabinet, located in the dining room area.

COMP III was completed during the visit and Mitigation plan was discussed.

Exit interview conducted and copy of report provided to Administrator.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC809 (FAS) - (06/04)

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