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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610483
Report Date: 01/29/2025
Date Signed: 01/29/2025 03:20:35 PM

Document Has Been Signed on 01/29/2025 03:20 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:LIFELONG SENIOR LIVINGFACILITY NUMBER:
197610483
ADMINISTRATOR/
DIRECTOR:		KAPIKYAN, ANDRANIKFACILITY TYPE:
740
ADDRESS:16003 LUDLOW STTELEPHONE:
(818) 371-5979
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 6DATE:
01/29/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:57 AM
MET WITH:Lewis Ndende, Nsikeloelo MauloaTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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In conjunction with complaint control numbers 31-AS-20241218081847 and 31-AS-20240822103213, Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Lewis Ndende and Nsikeloelo Mauloa and advised them of the visit.

With the assistance of staff, LPA took a tour of the physical plant. The facility is a one story building. The smoke alarms and carbon monoxide are dual and interconnected. There is one fire extinguishers, located in the living room. It was charged on 12/02/24.

Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. No sharps or cleaning supplies were observed out in the open during the day's inspection.

Bedrooms: There are four (4) bedrooms designated for residents' use. All bedrooms, in use by the residents were observed to be properly furnished with appropriate beddings and linens, with sufficient lighting.

Bathrooms: There are two (2) bathrooms designated for residents' use. Bedroom #4 has it's own bathroom. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured between 109 and 114 degrees Fahrenheit. No cleaning supplies were observed in either bathrooms during the day of the inspection.

Common Areas: These included the living room and dining area. The living room was furnished with two couches, coffee table, entertainment center and television. The dining room table is large enough to seat up to six (6) residents. Living room and dining room furniture where in good repair. Floors were mopped and clean. Exits and passageways were clear of obstruction.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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: LIFELONG SENIOR LIVING
FACILITY NUMBER: 197610483
VISIT DATE: 01/29/2025
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Surrounding Grounds: Entry/exits to the front and back yards were free of obstruction. There is a patio area that is furnished. The backyard space is large to hold outdoor activities. There are locked storage spaces used to keep cleaning supplies, located in the backyard/patio area. Gate at the backyard had no exterior lock and is clear to exit/evacuate in case of an emergency.

Laundry area: The laundry area is outside, located at the side of the home. Toxins and detergents not present at this time.

Staff Workstation/Office: There is a small office building at the front side of the home where files are kept.

Resident Files: Resident files are kept locked in staff office.

Staff Files: Staff files are also kept locked in the same office where resident files are kept.

Medications: Medications are stored in a locked closet by the front entry (medication closet). Medications were reviewed for proper storage and documentation.

Garage: The garage is a converted ADU. The ADU has it's own separate entry. It is inaccessible to the residents in care, and it does not intervene with the day to day operation of the facility.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, the physical plant is compliant with title 22. LPA will need to return on a Case Management-Annual Continuation to complete the Resident and Staff record review. Exit Interview Conducted and a Copy of the Report Issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
LIC809 (FAS) - (06/04)
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