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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610692
Report Date: 01/06/2025
Date Signed: 01/06/2025 09:04:44 PM

Document Has Been Signed on 01/06/2025 09:04 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:AURORA SENIOR LIVINGFACILITY NUMBER:
197610692
ADMINISTRATOR/
DIRECTOR:		TADEVOSYAN, LUSINEFACILITY TYPE:
740
ADDRESS:15918 NAPA STREETTELEPHONE:
(424) 499-9888
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 6CENSUS: 0DATE:
01/06/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Lusine Tadevosyan- AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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At 9:30 AM Licensing Program Analysts (LPA), Leslie Ngo-Castaneda conducted an announced pre-licensing visit to the above facility and met with administrator .

Fire Clearance was approved on 10.9.2024 for a maximum capacity of five (5) non-ambulatory residents and one (1) bedridden.

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. The facility is a single-story building. Today's site visit consisted of team touring the physical plant inside and outside and observed the following:

KITCHEN: The kitchen is equipped with a refrigerator, microwave oven and sink. At 9:36 AM, LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents.

FIRE EXTINGUISHER was last purchased on 10/1/2024 is located in the kitchen. First-aid is complete and new.

BEDROOMS: There are five (5) bedrooms designated for client use. All bedrooms are furnished with beds, dresser and required bedding and linen. Extra linen is available in the hallway cabinet. The bedrooms have sufficient closet space and have sufficient lighting. Facility will have awake staff. Bedroom #1 is shared and is located by the kitchen and living room. Bedroom #2, bedroom #3, bedroom #4, and bedroom #5 are private bedroom located by the hallway.



Continue to LIC 809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2025
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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AURORA SENIOR LIVING
FACILITY NUMBER: 197610692
VISIT DATE: 01/06/2025
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BATHROOMS: LPA observed two (2) bathrooms are clean and in good repair. Properly supplied with toilet papers, soap, and paper towels. The hot water temperature measured between 109.1°F. Bathroom #1 is located in the hallway in between by the entrance of the facility. Bathroom #2 is located in between bedroom #2 and bedroom #3 of the facility. Hot water for bathroom #2 measured at 110.4°F.

COMMON AREAS: The facility maintains a comfortable temperature at 72°F. The living room and dining appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Office is located, by the living room.

MEDICATION: The medications will be kept in the kitchen cabinet and LPA observed the cabinet kept locked and inaccessible to residents in care.

SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 10:07 AM they were tested and observed to be operational.


SURROUNDING GROUNDS: In the back of the facility has sufficient yard space. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. The backyard is fenced. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. There is a swimming pool or bodies of water in the backyard, this is lock and fenced. The driveway, passageway and entrance to the home was clear of obstructions.

GARAGE – is used as a storage. LPA observed laundry room is located in the locked garage. The washer/dryer appear to be in good condition. Laundry supplies are kept lock and inaccessible when not in use with supervision.

Component III was NOT conducted with the administrator and licensee. Needs further visit is required in order to meet the licensee. Facility is in compliance with Title 22 Regulations at this time. Exit interview was conducted and with a copy of this report was provided to the administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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