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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610606
Report Date: 10/29/2024
Date Signed: 10/29/2024 11:56:12 AM

Document Has Been Signed on 10/29/2024 11:56 AM - 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:ALL COMFORT BOARD AND CARE INC.FACILITY NUMBER:
197610606
ADMINISTRATOR/
DIRECTOR:		KHARATYAN, NINAFACILITY TYPE:
740
ADDRESS:18757 GAULT STREETTELEPHONE:
(370) 720-4551
CITY:RECEDASTATE: CAZIP CODE:
91335
CAPACITY: 6CENSUS: 5DATE:
10/29/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Nina Kharatyan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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At 9:45 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted a prelicensing visit. LPA met with Nina Kharatyan, Administrator and current staff and disclosed the reason for the visit.

Today’s prelicensing visit is conducted due to a change of ownership with five (05) residents in care. The previous facility was All Comfort Board and Care (197610261). All Comfort Board and Care was last visited on 09/16/2024 for an annual visit. The facility is a single story building with five (05) bedrooms, three (03) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for 6 non-ambulatory residents of which one (1) may be bedridden. LPA and the Administrator toured the facility inside and out and observed the following:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven, and a sink. Stove was observed in a good working condition. At 10:00 AM, LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. LPA observed a Fire Extinguisher and were last purchased on 01/30/2024. The Fire Extinguisher was observed hanging on the wall in the kitchen.

MEDICATION ROOM: The centrally stored medication will be kept in the in the locked cabinet in the kitchen. Residents and staff files will be kept locked in a cabinet in the kitchen and inaccessible to residents.



BEDROOMS: There are five (5) bedrooms designated for resident’s use. Bedrooms number three (3) and four (4) are shared. Bedroom (3) is used for a bedridden resident and bedroom one (1) and two (2) are private. All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were hardwired and were tested and observed to be operational.
Continue on LIC 809C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: ALL COMFORT BOARD AND CARE INC.
FACILITY NUMBER: 197610606
VISIT DATE: 10/29/2024
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BATHROOMS: There are three (3) bathrooms at the facility. LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and had non-skid mat The water temperature was noted at 107.6°.

LAUNDRY ROOM: The laundry room is located in the backyard of the facility and there is an extra locked storage room where all the laundry detergents and PPE supplies will be kept. The washer/dryer appear to be in good working condition.

COMMON AREAS: The facility maintains a comfortable temperature at 71°F. The living room and dining area
appeared clean and were properly furnished and has a television. No obstructions and or tripping hazards throughout the facility. LPA observed a working telephone for the facility.

SURROUNDING GROUNDS: The facility has sufficient backyard space. LPA did observe appropriate outdoor furniture in the backyard of the facility that can accommodate six (6) residents, LPA observed a covered shaded area for residents with some games for outdoor activities. There is no swimming pool or any bodies of water at the facility. The exit was free of any obstruction or hazard.

Garage/Storage: The facility does not have any extra garage and has two separate storage spaces. All the cleaning supplies will be kept in a locked cabinet outside of the kitchen.

SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 10:20 AM, they were tested and observed to be operational.

Between 11:15 AM to 12:00 PM, LPA reviewed three (3) resident and two (2) staff records. All residents and staff records appeared to completed.

Component III was conducted with the Licensee/Administrator.



Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and be notified by the CAB Analyst when your license has been approved.

Exit interview was conducted and with a copy of this report was provided to the Applicant/Administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
LIC809 (FAS) - (06/04)
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