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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610649
Report Date: 12/20/2024
Date Signed: 12/20/2024 02:31:28 PM

Document Has Been Signed on 12/20/2024 02:31 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:HAPPY RESIDENTS LIVING CENTERFACILITY NUMBER:
197610649
ADMINISTRATOR/
DIRECTOR:		NSHANIAN, HAKOPFACILITY TYPE:
740
ADDRESS:13127 BEAVER STTELEPHONE:
(818) 426-1413
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY: 6CENSUS: 0DATE:
12/20/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:13 PM
MET WITH:Art and Hakop "Jack" NshanianTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analysts (LPAs) Nadia Shahbazian and Michael Cava conducted a Pre-Licensing Inspection with the applicant representative and administrator, Art and Hakop Nshanian. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on May 14, 2024. A fire clearance was approved on September 13, 2024 for five (5) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six. The applicant will also be requesting a hospice waiver to retain six (6) residents. The smoke alarms and carbon monoxide detector are dual and inter-connected. The facility has a brand new fire extinguisher purchased on 09/13/24. Fire extinguisher is located at the kitchen. .

With the assistance of both the administrator and applicant representative, a tour of the physical plant was initiated 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 was an adequate supply of non-perishable food items observed. Perishable food items not required at this time as there are no residents. Administrator was advised facility needs to carry perishable food items once they admit residents for care. Knives were observed locked in a kitchen drawer. Cleaning supplies observed locked underneath the kitchen sink.

BEDROOMS: There are three (3) bedrooms designated for client use. All three bedrooms will be shared. One bedroom, Room #3 was used as a model room, which was furnished with two beds, 2 night stand, 2 chairs, a shared dress drawer, bedding and linen. The bedrooms have sufficient lighting. Per STD 850, all bedrooms qualify for a bedridden resident.

BATHROOMS: The facility has three (3) bathrooms. Bedroom #1 has it's own bathroom with shower. The other two bathrooms are located in the common area, by the kitchen and dining room. The bathrooms were
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
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: HAPPY RESIDENTS LIVING CENTER
FACILITY NUMBER: 197610649
VISIT DATE: 12/20/2024
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observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 107 degrees.


COMMON AREAS: These included the living room and dining room areas. The living room has a couch, chair, table, and television. There is a fireplace in the living room, properly screened. Fireplace is non-operational, and there were no fireplace tools present. The dining room has a table large enough to seat six (6) residents.

LAUNDRY ROOM: The laundry area is located in a separate, covered space, located in tha backyard. It will kept locked and inaccessible to residents.

MEDICATIONS: Medications will be kept locked in a kitchen cabinet.

SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility is large enough to hold outdoor activities. There was backyard furniture appropriate . There is no swimming pool.

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: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC809 (FAS) - (06/04)
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