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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610480
Report Date: 11/04/2024
Date Signed: 11/04/2024 12:53:33 PM

Document Has Been Signed on 11/04/2024 12:53 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:BEST CARE LAFACILITY NUMBER:
197610480
ADMINISTRATOR/
DIRECTOR:		MARINE STEPANYANFACILITY TYPE:
740
ADDRESS:15954 RAYEN STREETTELEPHONE:
(818) 489-0088
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 6CENSUS: 2DATE:
11/04/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Adrine Akopyan- LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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On 11.04.2024 in conjunction with an initial complaint visit control number 31-AS-20241025111603. Licensing Program Analyst (LPA) Leslie Ngo-Castaneda completed an unannounced CASE MANAGEMENT- Deficiencies visit. LPA met with Licensee Adrine Akopyan, explained the purpose of the visit.

During the facility tour at 9:50 AM . LPA observe the following:
  • S2 medication was kept in an unlock room in bedroom #1 and bedroom #2.
  • Chemicals were found to be kept in storage under the sink with beverages in the kitchen.



Per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiency was observed and cited (Refer to LIC 809-D).

Copy of this report provided, appeal rights given. Exit interview conducted.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
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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Document Has Been Signed on 11/04/2024 12:53 PM - It Cannot Be Edited


Created By: Leslie Ngo-Castaneda On 11/04/2024 at 12:24 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BEST CARE LA
FACILITY NUMBER: 197610480

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/05/2024
Section Cited
CCR
87465(h)(2)

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Incidental medical and dental Care: The following requirements shall apply to medications which are centrally stored:Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees
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Staff needs to lock and store their medication. POC was done during today with licensee. Medication was stored and lock away in the locked medicine cabinet.
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supervision of the centrally stored. This requirement is not met by S2 medication was seen in an unlock bedroom #1 and bedroom #2 that is accessible to the residents in the facility. This poses a potential health and safety risk to residents in care.
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Type A
11/05/2024
Section Cited
CCR87555(b)(24)

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General Food Service Requirements: The following food service requirements shall apply: (24) Pesticides and other toxic substances shall not be stored in food storerooms, kitchen areas, or where kitchen equipment or utensils are stored.
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Staff should not store checmicals with food/ beverages in the same storage. POC was done during today with licensee. Chemicals were stored in a lock storage cabinet in the bathroom located in the hallway.
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This requirement is not met by licensee where LPA saw cleaning supplies kept under the sink with beverages for consumption. This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nichelle Gillyard
LICENSING EVALUATOR NAME:Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2024


LIC809 (FAS) - (06/04)
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