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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610458
Report Date: 12/18/2023
Date Signed: 12/18/2023 12:04:09 PM

Document Has Been Signed on 12/18/2023 12:04 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:ECLIPSE SENIOR CAREFACILITY NUMBER:
197610458
ADMINISTRATOR:DISHOYAN, NERSESFACILITY TYPE:
740
ADDRESS:7045 BECKFORD AVENUETELEPHONE:
(818) 578-8933
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 6CENSUS: 3DATE:
12/18/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Armine DishoyanTIME COMPLETED:
12:15 PM
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At 9:30 am, Licensing Program Analyst (LPA) Huma Rahimi made a comprehensive Post Licensing visit to this facility and met with caregiver Anna Sahakyan. LPA observed three (3) residents present at the facility at the time of the visit. Administrator designee, Armine Dishoyan, arrived at the facility around 10:00 am. LPA informed the Administrator designee about the reason of today’s visit.

LPA toured the physical plant areas outside and inside, the resident's bedrooms, bathroom and personal accommodation. LPA reviewed the food service areas and food supply (perishable & nonperishable) as well as received the residents and staff records. The storage of toxic and hazardous items were locked and inaccessible to residents in care. The medication were observed locked in a cabinet located in the hallway adjacent to Room 4. The fire extinguisher was checked and the hot water temperature was measured in one of the bathrooms. The temperature measured at 114 degrees Fahrenheit in one of the bathrooms, which is the required range for residents comfort and safety. All required forms & poster were displayed on the facility's entrance wall. LPA observed the facility's temperature to be comfortable and was measured at 71 degrees Fahrenheit.

No citations were issued.


Exit Interview was conducted. Report was issued
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2023
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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