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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610658
Report Date: 02/25/2025
Date Signed: 02/25/2025 10:37:51 AM

Document Has Been Signed on 02/25/2025 10:37 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:IMPERIAL SENIOR CARE INCFACILITY NUMBER:
197610658
ADMINISTRATOR/
DIRECTOR:		MARGARYAN, HAYKFACILITY TYPE:
740
ADDRESS:10403 ENCINO AVETELEPHONE:
(727) 777-7477
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 1DATE:
02/25/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:37 AM
MET WITH:Hayk Margaryan, Hovhannes PapazyanTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with both administrators Hayk Margaryan and Hovhannes Papazyan. Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on May 30, 2024. The facility is a one story building. A fire clearance was approved on June 27, 2024 for six (6) non-ambulatory residents. No bedridden. The applicant is also requesting a hospice waiver to retain six (6) residents. The smoke alarms and carbon monoxide detector are dual, hard wired and inter-connected. The facility has one new fire extinguishers that was purchased on August 12, 2024.

With the assistance of both administrators, a tour of the physical plant was initiated and the following was observed:

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

BEDROOMS: There are three (3) bedrooms designated for client use. All bedrooms are shared. Bedroom #2 was used as a model room during inspection. Bedroom #2 was furnished with a bed, night stand, chair with sufficient lighting and closet space. Applicant was advised to fully furnish the other two rooms once residents are admitted.

BATHROOMS: The facility has two (2) bathrooms. Bedroom #21 has it's own bathroom with shower and tub. The other bathroom is located in the hallway. Both bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms was measured at 120 degrees.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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: IMPERIAL SENIOR CARE INC
FACILITY NUMBER: 197610658
VISIT DATE: 02/25/2025
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COMMON AREAS: These included the living room and dining room. The living room is equipped with two couches, a television and table. LPA observed a sufficient amount of board games for activities. The dining room table is large enough to seat up to six (6) residents. Both areas has sufficient space for mobility. Floors were clean and maintained. No fireplace. There were no visible immediate hazards.

LAUNDRY ROOM: The laundry room is located in the hallway. It was observed with a locked door to make it inaccessible to the residents. The washer/dryer are brand new. Cleaning supplies will also be maintained locked in the laundry room.

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

Staff/Resident Records: Applicant will maintain all staff and resident records in their main office, located in their other licensed facility next door to this one. Applicant was advised that records will be readily available upon licensing request during business hours and licensing inspections.

Garage: No garage.

SURROUNDING GROUNDS: 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 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 any other bodies of water.

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: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC809 (FAS) - (06/04)
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