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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610393
Report Date: 07/30/2024
Date Signed: 08/07/2024 06:02:07 PM

Document Has Been Signed on 08/07/2024 06:02 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:NEASISFACILITY NUMBER:
197610393
ADMINISTRATOR/
DIRECTOR:
GHAZARYAN, ANIFACILITY TYPE:
740
ADDRESS:8523 TERHUNE AVETELEPHONE:
(747) 250-9701
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 6CENSUS: 3DATE:
07/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Gevorg Khaluyan, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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This LIC809 has been generated to reflect signatures that did not register or associated on the previous report.
Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced required 1-yr inspection. LPA was allowed entry by Maria Durand, caregiver at 11:30am and explained the purpose of the visit. At 12:00pm, Gevorg Khaluyan, Administrator/Licensee arrived, LPA explained the purpose of the visit. LPA reviewed resident files, staff files and conducted a tour of the facility between 12:00pm to 3:00pm.

Outside: LPA toured the outside area. LPA observed a shaded sitting area for residents. There is a ramp access with sturdy hand railings. The facility does not have any bodies of water.

Common Area: LPA observed all furniture to be clean and in good repair. The facility maintains a comfortable temperature at 73 degrees Fahrenheit. The air conditioner is operational. The facility smoke alarm system is hard wired and interconnected. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. Sprinkler systems are hardwired and interconnected. At 1:30pm they were tested and deemed operational. Facility maintains a telephone land line and it was observed to be operational. Required postings were observed. The fire extinguishers is located in the kitchen with purchase date of 04/26/2024.

Food Service and Kitchen Area: The kitchen appliances were functional. The kitchen has a working stove, faucet, refrigerator and microwave. LPA found enough food for at least three (3) days perishable and seven (7) days non-perishable which are properly stored. Knives were stored in a magnetic lock drawer. Food preparation areas are clean. Garbage can have a tight fitting cover. The laundry room which is inaccessible and locked is located near the kitchen area. There is a functioning washer and dryer. Laundry detergents and cleaning solutions were stored in the locked laundry room. Residents' dining table accommodates six (6) people.


Continued to LIC809-C
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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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