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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610689
Report Date: 03/04/2025
Date Signed: 03/04/2025 11:37:29 AM

Document Has Been Signed on 03/04/2025 11:37 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:LUDLOW ASSISTED LIVING FACILITYFACILITY NUMBER:
197610689
ADMINISTRATOR/
DIRECTOR:		BALASANYAN, TATEVIKFACILITY TYPE:
740
ADDRESS:17832 LUDLOW STREETTELEPHONE:
(818) 304-1272
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 0DATE:
03/04/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Tatevik Balasanyan, Grigor PetrosyanTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with the applicant representatives Tatevik Balansanyan and Grigor Petrosyan. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on August 20, 2024. The facility is a one story building. A fire clearance was approved on December 5, 2024, for six (6) non-ambulatory residents, for a total capacity of six. All bedrooms have a fire clearance for 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 fire extinguisher is located by the kitchen. It was purchased on 12/05/24.

A tour of the physical plant was initiated at approximately 10:00am and the following was observed:

KITCHEN: The kitchen area is equipped with a refrigerator, stove/oven, microwave and sink. There is an adequate supply of nonperishable food items. No perishable items at this time as there are zero clients. Applicant was advised to purchase perishable items once facility admits clients. There is sufficient dining ware to accommodate a maximum capacity of six (6). Knives will be kept in a locked box and stored in one of the kitchen cabinets.

BEDROOMS: There are six (6) bedrooms designated for client use. All bedrooms are private. Per STD 850, all bedrooms have a bedridden fire clearance. The applicant furnished the resident bedrooms with a bed, night stand, chair, bedding and linen. The bedrooms have sufficient lighting and closet space.

BATHROOMS: The facility has six (6) bathrooms. Four (4) full and two (2) are half. Bedooms #1 and #6 has its own full bathroom. The other two full bathrooms are in the hallway. In addition, there are two half bathrooms designated for guest and staff. The bathrooms designated for resident use were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 114 degrees.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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: LUDLOW ASSISTED LIVING FACILITY
FACILITY NUMBER: 197610689
VISIT DATE: 03/04/2025
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COMMON AREAS: These included the living room and dining room. The living room is furnished with two couches, two chairs, a center table and television, The dining room table was large enough to sit up to six (6) individuals. There is no fireplace. Front entrance has a table for sign-in. All exit doors in the bedrooms and common areas were checked to insure the door alert is functional. There were no visible immediate hazards.

GARAGE: Facility does not have a garage.

LAUNDRY AREA: The laundry area is located in the hallway between the kitchen and client rooms. It was observed with a sliding door. Detergents and cleaning supplies are stored in a locked closet, across from the laundry area.

MEDICATIONS: The medications will be kept in a locked cabinet, located in the staff office/work station. A complete first aid kit and manual is also kept in the medication cabinet.

OFFICE/STAFF WORKSTATION: Staff workstation is located by the living room. Client and personnel files will be maintained in a locked cabinet there.

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 has outdoor 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 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: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC809 (FAS) - (06/04)
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