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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610666
Report Date: 01/07/2025
Date Signed: 01/07/2025 12:54:20 PM

Document Has Been Signed on 01/07/2025 12:54 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:WHITE DIAMOND RESIDENTIAL CAREFACILITY NUMBER:
197610666
ADMINISTRATOR/
DIRECTOR:		HAKOBYAN, ANIFACILITY TYPE:
740
ADDRESS:9837 ODESSA AVENUETELEPHONE:
(818) 810-5898
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 6CENSUS: 0DATE:
01/07/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Ani Hakobyan-LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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Licensing Program Analysts (LPAs) Nadia Shahbazian and Leslie Ngo-Castaneda conducted a Pre-Licensing Inspection with the licensee, Ani Hakobyan. An application to operate a Residential Care Facility for the Elderly (RCFE) was approved by Community Care Licensing (CCL) on June 1, 2024. A fire clearance was approved on September 5, 2024 for five (6) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six. The applicant was granted a hospice waiver to retain four (4) residents. The smoke alarms and carbon monoxide detectos are dual and inter-connected. The facility has a brand new fire extinguisher purchased on 06/08/2024. Fire extinguisher is located at the dining room.With the assistance of the licensee, 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, and sink. There was an adequate supply of perishable and non-perishable food items observed. Knives were observed locked in a kitchen drawer. Cleaning supplies observed locked underneath the kitchen sink and the laundry room.

BEDROOMS: There are four (4) bedrooms, three (3) are designated for client use. All three bedrooms will be shared. Bedroom #1, bedroom #2, and bedroom #3 are shared and will be for residents use. Bedroom #4 is located by the entrance of the facility and will be be used as staff room. All bedrooms were furnished with beds, night stand, dresser, beddings, and linens. The bedrooms have sufficient lighting. Per STD 850, bedroom 3 is designated for 1 bedridden resident.

BATHROOMS: The facility has two and half (2.5) bathrooms. Bathroom #1 is located by the hallway in between bedroom #2 and bedroom #3. Hot water measured at 108 degrees Fahrenheit. Bathroom #2 is located inside staff bedroom #4. Half bathroom (0.5) is located across the locked laundry room by the kitchen. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats.
Continue to LIC 809-C
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: WHITE DIAMOND RESIDENTIAL CARE
FACILITY NUMBER: 197610666
VISIT DATE: 01/07/2025
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COMMON AREAS: These included the living room and dining room areas. The living room has couches, telephone/cable and television. The dinning table is enough to fir eight (8) residents. Office is located beside the dining table. Fire place is close, non-operational and block off.

LAUNDRY ROOM: The laundry area is located in a separate, covered space, located in between the dinning room and staff bathroom. It will be kept locked and inaccessible to residents.

MEDICATIONS: Medications are kept locked in the lobby cabinet. First aid kit is complete.

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: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
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