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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610615
Report Date: 09/03/2024
Date Signed: 09/03/2024 02:12:24 PM

Document Has Been Signed on 09/03/2024 02:12 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:BE HAPPY, BE HOME 2FACILITY NUMBER:
197610615
ADMINISTRATOR/
DIRECTOR:		STEPANYAN, LILITFACILITY TYPE:
740
ADDRESS:17633 LOS ALIMOS STREETTELEPHONE:
(818) 400-1101
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 0DATE:
09/03/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:07 AM
MET WITH:Lilit StepanyanTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with the applicant representative/administrator, Lilit Stepanyan. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on April 10, 2024. A fire clearance was approved on April 15, 2024 for five (5) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six. The smoke alarms and carbon monoxide detector are dual and hard wired. The facility has a new fire extinguishers that was purchased on 03/01/24. It is located in the kitchen. The applicant is requesting a hospice waiver for six (6) residents.

A tour of the physical plant was initiated at approximately 10:20am and the following was observed:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, stove/oven, microwave oven and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives will be kept locked in a kitchen drawer.

BEDROOMS: There are four (4) bedrooms designated for client use. Bedroom #1 and #2 are private. Bedroom #3 and #4 are shared. Bedroom #2 has a fire clearance for bedridden (per STD 850). The applicant furnished the resident bedrooms with beds, night stand, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space.

BATHROOMS: The facility has three (3) bathrooms. Bedrooms #3 and #4 has it's own bathroom with shower, sink and toilet. There is a common bathroom located in the hallway, by bedroom #1. All three bathrooms were observed to have the proper fixtures, grab bars, and non-skid floors. The hot water delivered in the bathrooms measured between 105 to 110 degrees.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2024
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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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: BE HAPPY, BE HOME 2
FACILITY NUMBER: 197610615
VISIT DATE: 09/03/2024
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COMMON AREAS: These included the living room and dining area. The living room is equipped with a television, couch, love seat and two chairs. The dining area has a dinning room table large enough to accommodate six (6) residents. Floors were clean and in good repair. Hallways and passageways were clear of any obstruction. All exit doors were checked to insure that the auditory alert is functional. Required postings placed at the entrance. Ombudsman poster is posted by the kitchen, visible for residents and guest to see.

LAUNDRY AREA: The laundry area is located by Room #3. The washer/dryer is brand new. Detergents and fabric softner will be stored and locked underneath the kitchen sink.

MEDICATIONS: The medications and medication records will be kept locked in one of the upper kitchen cabinets located next to the refrigerator.

STAFF AND RESIDENT RECORDS: Staff and resident records will be kept locked in one of the lower kitchen cabinets located next to the refrigerator.

SURROUNDING GROUNDS: The front and backyard is gated. There are no exterior locks making passageways, entrance and exits clear of any obstruction. All entry and exit doors have a functional auditory alert when the doors open. The front yard of the facility has a small patio area with outdoor furniture to accommodate the six (6) residents. Front yard also has a storage cabinet where supplies will be kept locked. There is no swimming pools or bodies of water on the property.

In addition to the Pre-Licensing inspection, a Component III power point presentation was also held.

Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
LIC809 (FAS) - (06/04)
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