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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610676
Report Date: 01/08/2025
Date Signed: 01/08/2025 03:06:34 PM

Document Has Been Signed on 01/08/2025 03:06 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:AFFORDABLE BOARDING CAREFACILITY NUMBER:
197610676
ADMINISTRATOR/
DIRECTOR:		GALSTYAN, SONAFACILITY TYPE:
740
ADDRESS:733 CELTIC DRTELEPHONE:
(626) 310-3333
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 6CENSUS: 0DATE:
01/08/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Sona GalstyanTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 01/08/2025 Licensing Program Analyst (LPA) Melissa Spaeth conducted an announced pre-licensing visit to this facility and met with the Applicant, Sona Galstyan. This is a new application. A fire clearance dated 08/20/2024 was received for one (1) ambulatory resident and five(5) bedridden residents for a total capacity of six (6) residents. Bedroom one (1) is designated to house one (1) ambulatory resident, bedroom two (2) to house two (2) bedridden residents, bedroom three (3) to house two (2) bedridden clients, and bedroom four (4) to house one (1) bedridden client.

The purpose of today’s visit is to inspect the facility to ensure that it maintains compliance under California Code of Regulations, Title 22, Division 6. Component III was conducted with the applicant from 9:45 am until 11:30 am. Today’s site visit consisted of LPA touring the physical plant inside and outside from 11:30 am until 12:00 pm. LPA Spaeth observed the following:

Living Room/Office – the living room contained comfortable seating and a television. The room is also the facility office which contains two drawer cabinets. The resident and staff files will be locked within one of the cabinets.

Kitchen/Dining/Family Room - The knives were locked in a kitchen drawer and the medications will be locked in a kitchen cabinet. The washer/dryer are located in a closet within the kitchen. A fire extinguisher is located in the kitchen. The dining room section contained a dining room table and chairs. The family room contained comfortable seating, games, and a television.

Continued on 809-C

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AFFORDABLE BOARDING CARE
FACILITY NUMBER: 197610676
VISIT DATE: 01/08/2025
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Backyard - The backyard contained a designated area for outdoor activities. The side gate leading from the backyard to the front yard was not locked. LPA Spaeth observed a gazebo arrived during the visit.

Water Temperature - The water temperature was tested at 11:25 am and was 112.0 degrees F.

Bathrooms- There are four bathrooms which contained hand soap, slip resistant mats, paper towels, grab bars, and a trash can.

Bedrooms - There are four bedrooms which contained bed, linens, night stand, chest of drawers, a chair, and a closet.

Hallway Closet - The hallway closet contained linens.

Laundry Closet – A washer and dryer are located in the closet within the kitchen area.

Garage – the garage was locked and contained canned good items, cleaning solutions, hygiene items, and laundry detergent.

The smoke/carbon monoxide detectors were tested at 12:00 pm and were operable. The facility was clean and appears to be in good repair.

This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC809 (FAS) - (06/04)
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