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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610474
Report Date: 02/03/2025
Date Signed: 02/03/2025 01:27:44 PM

Document Has Been Signed on 02/03/2025 01:27 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:LINDLEY RESIDENTIAL CAREFACILITY NUMBER:
197610474
ADMINISTRATOR/
DIRECTOR:		AVETISYAN, ARMENUHIFACILITY TYPE:
740
ADDRESS:18126 W VINTAGE STREETTELEPHONE:
(818) 983-2224
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 6CENSUS: 5DATE:
02/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Larisa Bobakova, Lead CaregiverTIME VISIT/
INSPECTION COMPLETED:
01:26 PM
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On 02/03/25, at 9:40am, Licensing Program Analyst (LPA), Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with Lead Caregiver Larisa Bobakova and disclosed the purpose of the visit. LPA spoke to the administrator Armenuhi Avetisyan via telephone.

LPA asked for the census, resident, and staff files.

A physical tour was conducted at 11:05 AM and observed the following: Facility is a single-story home:



he Kitchen area was toured, and LPA observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. There are two (2) fire extinguishers; one (1) is located against the wall on your right-hand side towards the backyard. The other is located by the entrance of the facility with an expiration of 04/2025. There is a telephone line on the counter in the kitchen another telephone line by the entrance of the facility. There is extra, food in the kitchen pantries. The medications are locked and inaccessible to the residents in a black cabinet on your left-hand side at the entrance of the facility. The first aid kit is located on the top, black cabinet where the medication is kept. The knives are at the top of the kitchen counter on your right-side in a locked black box and inaccessible to the residents.

Outside/Backyard: The outside/backyard has furniture for the residents with proper seating. The facility does have a signal system. The facility does not have a pool/body of water. There is no garage.

LIC 809C-continued
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
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: LINDLEY RESIDENTIAL CARE
FACILITY NUMBER: 197610474
VISIT DATE: 02/03/2025
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Bedrooms: There is a total of six (6) bedrooms and six (6) bathrooms. Three (3) bedrooms and three (3) bathrooms that are located on the right side of the facility and three (3) bedrooms and three (3) bathrooms on the left side of the facility. There are two (2) bedrooms with a private bathroom. The other four (4) bedrooms do not have a private bathrooms but there are two (2) bathrooms on the left side and two (2) bathrooms on the right side. All bedrooms and bathrooms were toured and were properly furnished and have appropriate bedding, linens, toiletry, and lightning. The bathrooms have proper toiletry and grab bars. The bathroom temperatures of the water are within regulations reading at 114-117 degree Fahrenheit. There is two (2) pantries on your right side with extra linen and there is one (1) pantry on your left side with extra linen and one area that has the washer and dryer with chemicals locked and inaccessible to the residents.

The dining/living room area has enough seating for the residents and the staff with a large television.

The house temperature is at 73-degree Fahrenheit on both sides of the facility.

The smoke detector/carbon monoxide is in the hallway and is operable.




Administrative: There is an annual fee that is due right now. Towards the front of the facility on your left-hand side there is a facility sketch, House Rules, Disaster Plan, Resident Rights, Rights of Resident Council, Administrator License, Wifi connection instructions, Designation of facility, Resident Infection Control Plan and the surety bond with an expiration date of 04/2025.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025
LIC809 (FAS) - (06/04)
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