<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610679
Report Date: 10/10/2024
Date Signed: 10/10/2024 11:28:23 AM

Document Has Been Signed on 10/10/2024 11:28 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PALACE OF JOY 1FACILITY NUMBER:
197610679
ADMINISTRATOR/
DIRECTOR:		GRIGORYAN, MARINEFACILITY TYPE:
740
ADDRESS:18818 VALERIO STREETTELEPHONE:
(818) 699-2019
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 6CENSUS: 0DATE:
10/10/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Marine Grigoryan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At 09:30 am, Licensing Program Analyst (LPA), Huma Rahimi conducted an announced Pre-Licensing visit to the above facility and met with Marine Grigoryan, Licensee/Administrator and explained the reason for the visit. At the time of this visit LPA did not observe any residents present in the facility. Fire Clearance dated on 09/23/2024, and received for six (6) Non-ambulatory residents. Hospice wavier for six (6) residents. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6.

At 9:45 AM LPA conducted a physical plant tour and observed that Licensee family still resides in the address. LPA observed that the facility closets are filled with personal items. All bedrooms were observed to have hospital beds with bed rails. LPA advised licensee that this is not allowed since they can get a resident anytime when LPA approve of licensing. LPA and licensee agreed to conduct a subsequent pre-licensing visit another time.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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 1