197610475-3-4-2025-31-AS-MCAA-DEFUV4-20250304145432

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610475
Report Date: 03/04/2025
Date Signed: 03/04/2025 02:55:03 PM

Document Has Been Signed on 03/04/2025 02:55 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	LOVEBIRD SENIOR LIVING INC		FACILITY NUMBER:	197610475
ADMINISTRATOR/ DIRECTOR:	SARGSIAN, ARMINE		FACILITY TYPE:	740
ADDRESS:	13153 CONSTABLE AVENUE		TELEPHONE:	(818) 284-2502
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY: 6		CENSUS: 6	DATE:	03/04/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:41 PM
MET WITH:	Armine Sargsian		TIME VISIT/ INSPECTION COMPLETED:	03:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Armine Sargsian, and explained the reason for the visit. At approximately 12:45pm, LPA took a tour of the physical plant. The facility is a one story building, licensed to serve residents age 60 years and over. Required postings were observed in the entry area. The smoke alarms and carbon monoxide are dual, hardwired and interconnected. The facility has one new fire extinguisher, located in the kitchen. It was purchased on 03/03/25. KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, oven/stove, microwave oven and sink. There was an adequate supply of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives are locked in a kitchen drawer. No cleaning supplies were observed out and accessible to the residents during the day of the inspection. BEDROOMS: There are four (4) bedrooms designated for client use. Bedroom #1 and #3 are private, while bedrooms #2 and #4 are shared. Per STD 850, only bedroom #4 has the fire clearance for bedridden. All bedrooms, that are utilized by the residents are furnished with beds, night stand, chairs, dresser, bedding and linen. All the bedrooms have sufficient lighting and closet space. Exit doors in resident rooms were checked to insure the auditory signal is functional. BATHROOMS: The facility has two (2) bathrooms. Bedroom #4 has it's own bathroom with a bathtub, but it is not being used for the residents. Both bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 111 degrees. No cleaning supplies were observed in the open, or accessible to the residents during the day of the inspection.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LOVEBIRD SENIOR LIVING INC	FACILITY NUMBER: 197610475
	VISIT DATE: 03/04/2025

NARRATIVE

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COMMON AREAS: These included the living room which is equipped with a couch, three chairs, television, a coffee table and chess table. There is a fireplace with a screen but is non-operational. The key is stored and inaccessible to residents. No fireplace tools or fixtures present. The dining room table is large enough to accommodate between six (6) to eight (8). There were no visible immediate hazards. Floors were mopped and clean, and furniture were all in good repair.

GARAGE/LAUNDRY ROOM: The garage is attached to the home. The laundry room is located in the garage. Door to the garage has an alert to notify staff that the entry door to the garage is open. No cleaning supplies observed, or will be kept in the garage. Garage is also used as extra storage space for PPE supplies and emergency water.

MEDICATIONS: The medication cabinet is located in the dining room. Cabinet has a locking mechanism to insure medications will be inaccessible to residents.

OFFICE/STAFF WORKSTATION: Staff workstation is located next to the living room, by the back exit area. Resident and personnel files will be maintained in a locked filing cabinet there.

SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has a patio and backyard furniture to accommodate the six (6) residents. The facility backyard has sufficient yard space. There is no swimming pool or an other bodies of water.

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: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

LIC809 (FAS) - (06/04)

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