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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610685
Report Date: 12/27/2024
Date Signed: 12/27/2024 12:36:02 PM

Document Has Been Signed on 12/27/2024 12:36 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:ELDER JOY OASIS BOARDING CAREFACILITY NUMBER:
197610685
ADMINISTRATOR/
DIRECTOR:		AGARONYAN, LIANAFACILITY TYPE:
740
ADDRESS:7126 LURLINE AVETELEPHONE:
(818) 469-4447
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY: 6CENSUS: 0DATE:
12/27/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Agaronyan Liana - AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 12/27/2024 at 10:00AM Licensing Program Analyst (LPA), Perchui Milena Khurshudyan conducted an
announced Pre-Licensing visit to the above facility and met with facility Licensee/Administrator Liana Agaronyan.

Fire Clearance was approved on 09/05/2024 for a maximum capacity of six (6) residents, of which six (6) can be Non-ambulatory and one (1) Bedridden resident. Facility has Dementia Care Program. 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. The facility is a single-story building. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following:

KITCHEN: The facility has a Kitchen area that is equipped with a new refrigerator, microwave oven and sink.
At 10:15AM, LPA observed adequate supplies of nonperishable food properly stored in the cabinets and inside the supply room. Perishable food items are not required at this time as there are no residents in the facility. Licensee will supply sufficient amount of perishable food upon arrival of the residents. LPA observed dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to residents in care. The facility has one (1) new fire extinguisher, appeared to be full and serviced and were last purchased on 09/02/2024.

BEDROOMS: There are four (4) bedrooms designated for residents’ use. All bedrooms are furnished
with beds, dressers, chairs, nightstands and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational at 10:30AM. There is no bedroom designated for staff use. Facility will have awake staff at night. Emergency call buttons are available and will be provided to residents.
Continue on LIC809C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2024
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 3
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: ELDER JOY OASIS BOARDING CARE
FACILITY NUMBER: 197610685
VISIT DATE: 12/27/2024
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LAUNDRY ROOM: The laundry room is located next to the entrance door, LPA observed the door was properly locked. The washer/dryer appear to be new and in good condition. Laundry supplies along with other chemical items are kept locked inaccessible under supervision when not in use.

BATHROOMS: Facility has two (2) bathrooms. At 10:45AM LPA observed all bathrooms are clean, in good
repair and properly supplied with toilet papers, soap, and paper towels. LPA observed appropriate grab bars
and non-skid mats in all bathrooms. Trash cans had closed tight fitting lids throughout. Water temperature was within regulation, and it was measured by an LPA at 10:45AM to be at 113°F degrees. Bathrooms #1 is designated for Staff and residents’ use.

COMMON AREAS: The facility maintains a comfortable temperature at 70°F. The living room and dining area appeared clean and were properly furnished. Puzzles, coloring books, crayons, board games and other activity supplies are available for residents. No obstructions and or tripping hazards throughout the facility. An emergency exit plan/sketch is posted along the hallway with other posting requirements. No fire-arms observed or will be maintained on the premises.

MEDICATION ROOM: The medication will be centrally stored in the locked kitchen cabinet. Facility staff/resident files will be kept centrally stored and locked in the cabinet located next to the dining room. First-aid kit was checked to be complete and has the new manual available. Facility will have three (3) staff members, for each shift (AM and PM).

SMOKE DETECTORS/CARBON MONOXIDE. Dual smoke detectors and carbon monoxide were located in
the bedrooms and throughout the facility. At 11:00 AM they were tested and observed to be operational.

Continue on LIC809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ELDER JOY OASIS BOARDING CARE
FACILITY NUMBER: 197610685
VISIT DATE: 12/27/2024
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SURROUNDING GROUNDS: The facility has sufficient yard space. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. The backyard is fenced. There is no garage in the property, it has been converted to an ADU. LPA discussed the importance of maintaining the care and supervision to meet the needs of the residents. No bodies of water were observed. The facility has land line LPA checked to be operational.

Component III was conducted with the Administrator.

Based on inspection and observation, the physical plant is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and the applicant will be notified by the CAB Analyst when the license has been approved.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024
LIC809 (FAS) - (06/04)
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