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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610643
Report Date: 08/19/2024
Date Signed: 08/19/2024 04:12:04 PM

Document Has Been Signed on 08/19/2024 04:12 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:A-Z COMFORTFACILITY NUMBER:
197610643
ADMINISTRATOR/
DIRECTOR:		VAHRAMYAN, SUSANNAFACILITY TYPE:
740
ADDRESS:10752 BAIRD AVETELEPHONE:
(818) 404-1988
CITY:NORTHRIDGESTATE: CAZIP CODE:
91326
CAPACITY: 6CENSUS: 0DATE:
08/19/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Ani Mkritchyan- LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Mariana Agban conducted a Pre-Licensing Inspection with facility Administrator Susanna Vahramyan and Licensee Ani Mkritchyan. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on May,28,2024.
A fire clearance was approved on June 26, 2024 for a maximum capacity of five (5) non- ambulatory adults, one(1) Bedridden adult.

A tour of the physical plant was initiated at 9:30 am and the following was observed:
Required postings were observed in the entry area. The smoke alarms and carbon monoxide detector are battery operated and were functional. Fire extinguisher purchase date is 06/17/24

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6) residents.
BEDROOMS: There are four (4) bedrooms designated for residents use. Two (2) bedrooms are designated to be shared rooms and two (2) bedrooms are designated to be private use. All bedrooms are furnished with dressers and required bedding and linen. The bedrooms have sufficient closet space. Each bedroom had emergency flash light. LPA observed an additional room, Administrator stated that the room will be an office room. BATHROOMS: The facility has three (3) bathrooms. one (1) main bathroom in the main hallway and one (1) in the bedroom #4 for the residents in that room to utilize and one (1) for staff use. The hot water delivered in the bathroom sink was measured at 108.9. COMMON AREAS: These included the living room and dining room, which were equipped with furniture, a television, sofa. There is a fireplace in the living room. It is non-operational. No fireplace tools or fixtures present. The auditory alarms on all exit doors were on and functional at the time of the visit. Laundry Area: The washer/dryer appear to be in good condition.Laundry cabinets will be locked and thus laundry detergents are inaccessible to residents. Garage: LPA observed extra storage cabinets in the garage. Garage door will be locked all times. MEDICATION: The medication will be kept in a locked cabinet in the hallway.
(Continue 809C)
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2024
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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: A-Z COMFORT
FACILITY NUMBER: 197610643
VISIT DATE: 08/19/2024
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 SURROUNDING GROUNDS: The backyard of the facility has a patio and backyard furniture to accommodate the six (6) residents. The facility backyard has sufficient yard space. There is no swimming pool or bodies of water. The side gate was checked to insure it was clear of obstruction.

Staff and resident files: Staff and resident files will be kept and maintained in a locked cabinet in the office room.


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: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC809 (FAS) - (06/04)
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