197610419-3-13-2025-31-AS-ASEA-DEQSHK-20250313135340

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610419
Report Date: 03/13/2025
Date Signed: 03/13/2025 01:53:53 PM

Document Has Been Signed on 03/13/2025 01:53 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:	ALL STAR CARE INC		FACILITY NUMBER:	197610419
ADMINISTRATOR/ DIRECTOR:	DARABEDYAN, IVETA		FACILITY TYPE:	740
ADDRESS:	36240 52 ST EAST		TELEPHONE:	(818) 624-6006
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93552
CAPACITY: 6		CENSUS: 3	DATE:	03/13/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Iveta Darabedyan- Administrator		TIME VISIT/ INSPECTION COMPLETED:	02:20 PM

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On 3/13/2025 at approximately 09:30 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the caregiver and LPA stated the reason for their visit. Administrator Iveta Darabedyan arrived shortly after to assist with today’s visit.

LPA asked for the census and Staff/Resident Roster. LPA conducted a physical plant tour at approximately 11:30 AM and the following was noted:

The facility is a single unit building with five (5) bedrooms and three (3) bathrooms currently occupying three (3) residents. There is one (1) designated staff room with one (1) private bathroom. The facility has an approved fire clearance for six (6) non-ambulatory residents, one (1) of which may be bedridden. The facility has an approved Hospice waiver for six (6) residents. Sign in sheet, hand sanitizer, gloves and masks are available. LPA observed required posting such as See/Say Something, Long-Term Ombudsman, and Facility Sketch located immediately upon entrance.

Common areas: These include the living room, the dining room, and Staff Office. All rooms were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 71°F. A fireplace was observed to be covered and inaccessible to residents. A working telephone was observed.

Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. Knives and sharps were observed to be kept in a locked cabinet near the kitchen stove. LPA observed cleaning solutions and toxins to be kept locked underneath kitchen sink inaccessible to residents. Kitchen appliances were observed to be working and in proper condition. LPA observed a fire extinguisher to be located near the kitchen and dated 03/13/25. (continued on LIC 809-C)

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALL STAR CARE INC	FACILITY NUMBER: 197610419
	VISIT DATE: 03/13/2025

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Bedrooms: The residents’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Extra linens/covers were observed stored in a storage closet located in the hallway’s passageway.

Bathrooms: The bathrooms were checked for cleanliness and proper operation. Appropriate grab rails and non-slip mats were observed and in proper condition. The hot water temperature was measured within regulations.

Garage: The garage can be accessed from inside of the facility and was observed to be kept locked and inaccessible to residents. Laundry Room: The laundry room is located near the garage. LPA observed laundry room to be kept locked and cleaning solutions properly stored within laundry room and inaccessible to residents. Laundry appliances observed to be working and in proper condition.

Staff Room: LPA observed staff room locked and inaccessible to residents.

Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. There is no body of water located at the facility.

Medications: Medications were observed to be kept in a locked cabinet located in the kitchen. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer, and First Aid manual. The Smoke detectors and carbon monoxides were observed to be working properly and were tested.

Residents/Staff Records: LPA conducted a complete file review of resident records. Resident records appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated.

There were no immediate health and safety hazard observed during the day of inspection. Exit interview conducted and a copy of this report was provided to the Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC809 (FAS) - (06/04)

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