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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610422
Report Date: 10/11/2024
Date Signed: 10/11/2024 12:22:24 PM

Document Has Been Signed on 10/11/2024 12:22 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:TERNER HEALTHFACILITY NUMBER:
197610422
ADMINISTRATOR/
DIRECTOR:		YAZICHYAN, EMANUELFACILITY TYPE:
740
ADDRESS:4717 WEST AVENUE M4TELEPHONE:
(661) 802-7960
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 6CENSUS: 0DATE:
10/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Emanuel YazichyanTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Evelin Rios arrived at the facility above to conduct an annual required visit. LPA was greeted by the administrator Emanuel Yazichyan. LPA explained the reason for the visit. Administrator stated the facility has not admitted any residents. This facility is licensed as an Residential Care Facility for the Elderly with approved fire clearance for (5) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six (6) residents. Facility has a Hospice waiver for four (4) residents. LPA confirmed annual licensee fee has been paid.

LPA conducted a physical plant tour of the facility. In the kitchen LPA observed appliances such as the refrigerator, stove and dishwasher operational. LPA observed fire extinguishers through out the facility, fully charged. Administrator tested the dual carbon monoxide and fire detectors at 11:19 a.m. LPA observed detectors operational.

LPA discussed with the Emanuel the administrator certification requirement. LPA requested required documentation for administrator certification, 1st aid and CPR be emailed to LPA. Administrator informed LPA they have applied for the Assisted Living Waiver (ALW) but if they do not admit residents through the ALW program they are considering congregate living. LPA also did not observe portable or permanent closets and drawer space in the resident bedrooms. Administrator informed LPA the large furniture is on hold near by for safe keeping while the home is vacant. Inspection Tool not used for today's visit. LPA informed administrator to update CCL if they decide to cease operation.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, there were no deficiencies observed during today's visit. Exit interview conducted. Copy of the report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2024
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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