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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610711
Report Date: 02/11/2025
Date Signed: 02/12/2025 12:30:40 PM

Document Has Been Signed on 02/12/2025 12:30 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:NORTHRIDGE COMMUNITY BOARDING CARE INC.FACILITY NUMBER:
197610711
ADMINISTRATOR/
DIRECTOR:		HARUTYUNYAN, ARMINEFACILITY TYPE:
740
ADDRESS:8928 WHITAKER AVETELEPHONE:
(323) 640-3016
CITY:NORTHRIDGESTATE: CAZIP CODE:
91343
CAPACITY: 6CENSUS: 0DATE:
02/11/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:27 AM
MET WITH:Armine Harutyunyan- AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:05 PM
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Licensing Program Analysts (LPA) Leslie Ngo-Castaneda conducted a Pre-Licensing Inspection with the licensee, Diana Navasardyan, and Armine Harutyunyan who is the administrator. An application to operate a Residential Care Facility for the Elderly (RCFE) was approved by Community Care Licensing (CCL) on October 11, 2024. A fire clearance was approved on January 21, 2025 for two (2) ambulatory residents. three (3) non-ambulatory, and one (1) bedridden resident, for a total capacity of six. The applicant was granted a hospice waiver to retain four (4) residents. The smoke alarms and carbon monoxide detectors are dual and inter-connected. The facility has a brand new fire extinguisher purchased on 06/08/2024. Fire extinguisher is located at the dining room. With the assistance of the administrator, LPA took a tour of the physical plant was initiated and the following was observed:

KITCHEN: The facility has a kitchen area that is equipped with a refrigerator, stove/oven, and sink. There was an adequate supply of perishable and non-perishable food items observed. Knives were observed locked in a kitchen drawer. Cleaning supplies observed locked underneath the kitchen sink and the laundry room.

BEDROOMS: There are four (4) bedrooms at the facility, all of the bedrooms are going to be used for residents. Bedroom #1 is shared where bedridden resident and bedroom #4 is shared as well for non-ambulatory residents. Bedroom #2 and bedroom #3 are private and will be for ambulatory residents. All bedrooms were furnished with beds, night stand, dresser, beddings, and linens. The bedrooms have sufficient lighting.


Continue to LIC 809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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: NORTHRIDGE COMMUNITY BOARDING CARE INC.
FACILITY NUMBER: 197610711
VISIT DATE: 02/11/2025
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BATHROOMS: The facility has two bathrooms. Bathroom #1 is located by the hallway in between bedroom #2 and bedroom #3. Hot water measured at 118.6 degrees Fahrenheit. Bathroom #2 is located beside bedroom #1. Hot water measured at 118.6 degrees Fahrenheit. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats.

COMMON AREAS: These included the living room and dining room areas. The living room has couches, telephone/cable and television. The dinning table is enough to for six (6) residents. Office is located beside the kitchen. Fire place is close, non-operational and block off located in the dining room.

LAUNDRY ROOM: The laundry area is located beside the kitchen, cleaning supplies will be kept locked and inaccessible to residents under the kitchen sink.

MEDICATIONS: Medications are kept locked in the kitchen drawer. First aid kit is complete.

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 is
large enough to hold outdoor activities. There was backyard furniture appropriate. There is no swimming
pool.

In addition to the Pre-Licensing inspection, a Component III power point presentation was also 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: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC809 (FAS) - (06/04)
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