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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610383
Report Date: 01/19/2024
Date Signed: 01/19/2024 02:52:16 PM

Document Has Been Signed on 01/19/2024 02:52 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:SWEET TOUCH ASSISTED LIVINGFACILITY NUMBER:
197610383
ADMINISTRATOR:KIRAKOSYAN, SEROZHFACILITY TYPE:
740
ADDRESS:31350 157TH STREET ETELEPHONE:
(818) 621-0072
CITY:LLANOSTATE: CAZIP CODE:
93544
CAPACITY: 6CENSUS: 0DATE:
01/19/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:KIRAKOSYAN, SEROZH - AdministratorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPAs) Gary Tan and Michael Cava conducted a Pre-Licensing Inspection with the applicant representative Serozh Kirakosyan. The applicant is "Sweet Touch Assisted Living". A fire clearance was approved on 11/17/23 for six (6) non-ambulatory residents, one (1) of which may be bedridden. The applicant is also requesting a hospice waiver to retain six (s) residents.

A tour of the physical plant was initiated at approximately 11:30 AM and the following was observed:

KITCHEN: The facility has a Kitchen that is equipped with a refrigerator, microwave, stove, dishwasher and sink. There was an adequate supply of perishable and nonperishable food. Knives were observed locked in a kitchen cabinet. Cleaning supplies will be stored under the sink cabinet which was locked during visit.

BEDROOMS: There are four (4) bedrooms designated for client use, two (2) shared and two (2) private. The applicant furnished the resident bedrooms with beds, night stand, chairs, dressers, bedding and linen. The bedrooms have sufficient lighting and storage.

BATHROOMS: The facility has two (2) shared bathrooms and a third bathroom designated for staff and visitors use only. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water temperature was measured at a range of 110.9°F to 117.6°F.

COMMON AREAS: These included the living room and the dining area. Living room was furnished with chairs and side tables. The dining area was furnished with a television, a coffee table and chairs to sit the capacity of the facility. There were no visible immediate hazards. Cleaning supplies and chemicals are stored and locked in a cabinet by the laundry area. There is a working telephone line accessible to residents in the living room. Dual smoke/carbon monoxide alarms were tested and observed to be operable. Fire extinguisher is located in the kitchen and last bought on 06/16/23. (continued on LIC 809-C)

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2024
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SWEET TOUCH ASSISTED LIVING
FACILITY NUMBER: 197610383
VISIT DATE: 01/19/2024
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(continued from LIC 809)

LAUNDRY ROOM: The laundry room is located in the hallway by the kitchen opposite the garage door. Laundry detergents and other cleaning agents were locked in a cabinet beside the washer and dryer.

MEDICATIONS: The medication cabinet is located in the living room and has has a locking mechanism. A complete first aid kit is located inside the medication cabinet.

Staff/Resident Records: Staff and resident records will be kept in the filing cabinet inside the garage.

SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has a covered patio and backyard furniture to accommodate the residents. The facility backyard has sufficient yard space. There is a tool shed located in the backyard and observed to be locked and inaccessible. There is no body of water in the facility.

Component III was conducted with the applicant Serozh Kirakosyan by LPA Cava. Pre-licensing Inspection completed. No deficiencies were observed.

This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.

Exit interview conducted. Report signed and delivered.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
LIC809 (FAS) - (06/04)
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