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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610715
Report Date: 01/31/2025
Date Signed: 01/31/2025 03:40:16 PM

Document Has Been Signed on 01/31/2025 03:40 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:A COZY CHATEAUFACILITY NUMBER:
197610715
ADMINISTRATOR/
DIRECTOR:		ABALAJON, SEANFACILITY TYPE:
740
ADDRESS:1831 SHERER LANETELEPHONE:
(747) 342-9509
CITY:GLENDALESTATE: CAZIP CODE:
91208
CAPACITY: 6CENSUS: 0DATE:
01/31/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Sean AbalajonTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst Abeye Duguma (LPA) conducted an announced Pre-licensing visit at 01:30 PM and met administrator, Sean Abalajon. LPA conducted an entrance interview with the Administrator.

With the assistance of the Administrator, LPA conducted a facility tour of both the inside and outside. The facility was inspected for Fire Safety, Personal Accommodations and Services, Medication Procedures and Food Service. This is a single-story property. Fire Clearance is approved for six (06) non-ambulatory of which one (01) may be bedridden resident.

Facility has six (06) bedrooms, of which five (05) are for residents and four (04) bathrooms. Resident bathroom has properly installed grab bars and shower has non-skid mats. Hot water temperature measured at 108.3ºF during the visit. All residents’ bedrooms were adequately furnished. The linens were stored in the storage space located in the hallway cabinets.

The common areas were appropriately furnished and had adequate furniture. The LPA observed entertainment equipment and games for activities. The records were stored in a file cabinet located in kitchen nook. The first-aid kit is complete. At the time of the visit, facility had water, perishable and nonperishable food supplies should they admit a resident(s). LPA observed a fireplace that has appropriate screen.

LPA inspected the kitchen and observed the stove and refrigerator to be clean and working. Sharps are stored in a locked kitchen cabinet.

Smoke detectors and Carbon Monoxide detectors were checked and function properly. There are two (02) fully charged fire extinguishers located in the kitchen area and hallway. Fire extinguishers were certified on 12/06/2024.

(CONT. on LIC809-C)

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025
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 2
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: A COZY CHATEAU
FACILITY NUMBER: 197610715
VISIT DATE: 01/31/2025
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LPA Duguma observed a washer and dryer in the laundry room at the end of the hallway to the right. All toxins were stored in a cabinet under the sink.

There is sufficient outdoor space with seating and a shaded area with proper furniture for outdoor use. Facility has two (02) empty water fountains and a swimming pool with appropriate locked fencing.

At the time of this visit the physical plant is meeting Title 22 requirements.

The Component III completed with LPA.

No health and safety hazard were noted during this visit.

Exit interview was conducted and a copy of report was issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC809 (FAS) - (06/04)
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