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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610622
Report Date: 12/03/2024
Date Signed: 12/03/2024 05:23:11 PM

Document Has Been Signed on 12/03/2024 05:23 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:HAPPY DAYS ASSISTED LIVINGFACILITY NUMBER:
197610622
ADMINISTRATOR/
DIRECTOR:		HAKOBYAN, MARINEFACILITY TYPE:
740
ADDRESS:8434 DAY STTELEPHONE:
(818) 590-4682
CITY:SUNLANDSTATE: CAZIP CODE:
91040
CAPACITY: 6CENSUS: 0DATE:
12/03/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Romeo Balasanyan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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At 10:30am Licensing Program Analysts (LPA) Leizl de la Cerra conducted an announced Pre-Licensing Inspection to the above facility and met with administrator, Romeo Balasanyan The LPA will inspect the facility to ensure compliance with the rules and regulations under California Code of Regulations, Title 22, Division 6.

Fire Clearance was approved on 04/29/2024 for a maximum capacity of six (6) residents, of which five (5) are for non-ambulatory and one (1) for a bedridden resident in bedroom #3. The facility is a single-story building with no garage. At 11:00am, with the assistance of the administrator, LPA conducted a facility tour of both the inside and outside premises and observed the following:

KITCHEN: The kitchen is equipped with a refrigerator, stove, microwave oven and sink. LPA observed adequate supplies of 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.

BEDROOMS: There are three (3) bedrooms designated for resident use. Bedroom #3 is cleared for one (1) bedridden. All bedrooms are furnished with a night stand, a chair, a lamp, a chest of drawers, a closet and a bed with clean bedding and linens. All bedrooms have sufficient closet space and have sufficient lighting.
BATHROOMS: LPA observed two (2) bathrooms that are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured between 114°- 118°F. LPA observed the appropriate grab bars by the toilet and in the shower areas. LPA observed non-skid mats in the shower area.

Continued to LIC809-C
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: HAPPY DAYS ASSISTED LIVING
FACILITY NUMBER: 197610622
VISIT DATE: 12/03/2024
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COMMON AREAS: The facility maintains a comfortable temperature at 70°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the common area.

SURROUNDING GROUNDS: LPA observed the backyard provided a covered seating area with the appropriate outdoor furnitures, available for residents to use.



LAUNDRY AREA: LPA observed laundry area located by the kitchen area. The washer/dryer appear to be in good condition.

Cleaning solutions, laundry detergents and other hazardous cleaning materials are kept inaccessible in a locked cabinet located in the kitchen area.
The medications, resident files and staff files will be kept in locked cabinet in the kitchen area which is inaccessible to residents in care. The first-aid kit is complete. The facility smoke alarm system is hard wired and interconnected. The fire extinguisher is located in the kitchen area and was observed to be fully charged and was last purchased on 04/15/24. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. Alarms were tested and observed to be operational.

Component III Orientation was conducted with the administrator/applicant during the visit.
LPA de la Cerra will notify the Centralized Applications Bureau (CAB) Analyst of the completed Pre-Licensing inspection. The CAB Analyst will notify applicant when license is approved.
Exit interview was conducted and a copy of the signed report has been emailed to the applicant.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
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