197610414-8-15-2023-31-AS-MCAA-CUQPLE-20230815112438

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610414
Report Date: 08/15/2023
Date Signed: 08/15/2023 11:25:30 AM

Document Has Been Signed on 08/15/2023 11:25 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:	HEALTHY LIFE FAMILIES		FACILITY NUMBER:	197610414
ADMINISTRATOR:	DISHOYAN, ARMINE		FACILITY TYPE:	740
ADDRESS:	17355 HORACE STREET		TELEPHONE:	(559) 907-1184
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY: 6		CENSUS: 4	DATE:	08/15/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Arusyak Ohanyan, Armine Dishoyan		TIME COMPLETED:	11:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Christopher Alemoh and Michael Cava conducted a Component III and Pre-Licensing Inspection with the applicant representative Arusyak Ohanyan and administrator, Armine Dishoyan and Roza Tonoyan. A Change in Owner (CHOW) Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on February 13, 2023. A fire clearance was approved on March 14, 2023 for six (6) of which five (5) may be non-ambulatory and one (1) bedridden, for a total capacity of six. The applicant is also requesting a hospice waiver to retain six (6) residents. The smoke alarms and carbon monoxide detector are dual. The facility has a new fire extinguisher, located in the kitchen, that was purchased on May 18, 2023. KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives and utensils were observed locked in a kitchen drawer. There was also a sufficient amount of kitchenware for resident use. BEDROOMS: There are four (4) bedrooms designated for client use. Bedroom #1 and #4 are cleared to be private, with bedroom #1 having a bedridden fire clearance (per STD 850). Bedrooms #2 and #3 are semi-private rooms. The applicant furnished the resident bedrooms with beds, night stand, chairs, dresser, bedding and linen. All four bedrooms have sufficient lighting and closet space. BATHROOMS: The facility has three (3) bathrooms. Bedrooms #1 and #4 has it's own bathroom with shower. The bathroom in bedroom #1 has it's own bath tub, but will not be used by the resident at this time. The third bathroom is located in the hallway by bedroom #1. All bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 106 degrees.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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: HEALTHY LIFE FAMILIES	FACILITY NUMBER: 197610414
	VISIT DATE: 08/15/2023

NARRATIVE

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COMMON AREAS: These included the tv and activity room which were equipped with living room furniture, a television, tables and chairs. There is a fireplace with a screen and a glass slide. It is non-operational. According to the applicant and administrator, the gas is turned off. There were no fireplace tools or fixtures present. The dining area has a large dining room table to accommodate six (6). There were no visible immediate hazards.

LAUNDRY ROOM: The laundry room is located in the kitchen. It was observed with a locked door to make it inaccessible to the residents. Laundry detergents and cleaning supplies will be maintained in the laundry room.

MEDICATIONS: The medications are kept in a medication closet located near the dining area. The closet was observed locked and inaccessible to the residents.

STAFF WORKSTATION: Staff workstation is located in the kitchen. There was a desk in place for staff use. Staff and resident records will be maintained at the workstation where there is a filing cabinet with a locking mechanism, where records will be filed.

SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors including the front and back doors, and exit door in resident room #1 and #4 have a functional auditory alert when the doors open. Proper ramps were in place at the front door, and at resident room #1 and #4. The backyard of the facility has backyard furniture to accommodate the six (6) residents. The facility backyard has sufficient yard space for leisure and activities. There is no swimming pool or bodies of water.

In addition to the Pre-Licensing inspection, a Component III power point presentation was also held.

Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

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