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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610414
Report Date: 12/07/2024
Date Signed: 12/07/2024 11:21:37 AM

Document Has Been Signed on 12/07/2024 11:21 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 FAMILIESFACILITY NUMBER:
197610414
ADMINISTRATOR/
DIRECTOR:		HELEN TERZYANFACILITY TYPE:
740
ADDRESS:17355 HORACE STREETTELEPHONE:
(559) 907-1184
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 4DATE:
12/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:13 AM
MET WITH:Arusyak OhanyanTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with administrator, Arusyak Ohanyan, and explained the reason for the visit.

With the assistance of the administrator, LPA took a tour of the physical plant. The facility is a one story building. Required postings were observed in the entry area. The smoke alarms and carbon monoxide detector are dual. The fire extinguisher is located in the kitchen. It was purchased on 08/24/24

KITCHEN: The kitchen area is equipped with a refrigerator, stove/oven, microwave oven and sink. There were adequate supplies of perishable and nonperishable food. Knives and utensils were observed locked in a kitchen drawer. Cleaning supplies were stored and locked away, inaccessible to the residents.

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 a 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 between 107-111 degrees.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: 12/07/2024
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COMMON AREAS: These included the living room and dining room area. The living room has two couches, a tabe, and television. The fireplace is properly screened with a glass door. No fireplace tools were present. The dining room has a table large enough to seat up to six (6) residents. The floors were mopped and clean. Furniture is in good repair. Passageways and hallways were clear of obstruction.

LAUNDRY ROOM: The laundry area is located by the kitchen. It was observed with a locked door to make it inaccessible to the residents. Laundry detergents and cleaning supplies were locked inside.

MEDICATIONS: The medication closet is located by the dining room. It was locked during the visit. Medications and medication records were checked for proper storage and documentation.

STAFF WORKSTATION: Staff workstation is located in the kitchen. There is a desk in place for staff use. Staff and resident records are maintained in a locked cabinet there.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

SURROUNDING GROUNDS: 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. Driveway was clear of any obstruction.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a copy of the Report Issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2024
LIC809 (FAS) - (06/04)
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