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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610731
Report Date: 03/11/2025
Date Signed: 03/11/2025 02:23:27 PM

Document Has Been Signed on 03/11/2025 02:23 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:WELLCARE HOMEFACILITY NUMBER:
197610731
ADMINISTRATOR/
DIRECTOR:		OHANYAN,ARUSYAKFACILITY TYPE:
740
ADDRESS:3133 DONA SARITA PLTELEPHONE:
(818) 424-2217
CITY:STUDIO CITYSTATE: CAZIP CODE:
91604
CAPACITY: 6CENSUS: 0DATE:
03/11/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Moe Saki and Administrator/Arusyak OhanyanTIME VISIT/
INSPECTION COMPLETED:
02:21 PM
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Licensing Program Analyst (LPAs) Nadia Shahbazian conducted a Pre-Licensing Inspection with the Moe Saki/Licensee and Arusyak Ohanyan/Administrator. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on December 02, 2024. A fire clearance was approved on January 21, 2025 for six (6) non-ambulatory residents, one (1) of whom may be a bedridden resident. Bedroom #2 is approved for the bedridden resident. The applicant will also be requesting a hospice waiver to retain five (5) residents.

With the assistance of the administrator, a tour of the physical plant was initiated at 10:40 and the following was observed:

The smoke alarms and carbon monoxide detectors are dual and inter-connected. LPA observed the detectors in each room. At 11:08am smoke and carbon monoxide detectors were tested and were observed to function properly. The facility has a brand new fire extinguisher purchased on 12/15/24. Fire extinguisher is located by the kitchen exit door. There is a ramp at the front entry and there are several exit doors which lead to the side yard. There is one (1) exit door in the kitchen, two (2) in the dining room and two (2) exits doors in the living room. The living room exit doors will be used as the main exit during emergencies.

COMMON AREAS: LPA observed television, games and activities in the living room. The living room has couches, telephone/cable/internet and television. The dining area has a large dining room table and chairs to accommodate six (6) residents.

OFFICE/STAFF WORKSTATION: Located by the dining room. Staff and resident files will be maintained in locked cabinets.

MEDICATIONS: The medications will be kept locked in the Office/Staff workstation. LPA observed a complete First Aid Kit and the First Aid Manual in the office workstation.



Continued in 809-C



SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WELLCARE HOME
FACILITY NUMBER: 197610731
VISIT DATE: 03/11/2025
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KITCHEN: The kitchen area that is equipped with a refrigerator, stove/oven, two (2) microwave ovens and two (2) dishwashers. There was an adequate supply of non-perishable food items and dishes. Perishable food items are not required at this time as there are no residents. Knives were observed locked in a kitchen drawer. Cleaning supplies observed locked underneath the kitchen sink.

BEDROOMS: There are three (3) shared bedrooms designated for client use. Room #2 was prepared as a model room, which was furnished with two beds, 2 night stands, 2 chairs, closets, dresser drawers, bedding, linens. All bedrooms have sufficient lighting. Per STD 850, bedroom #2 is designated for the bedridden resident.

BATHROOMS: The facility has two (2) bathrooms for residents' use and one (1) half bathroom for staff use. Bedroom #2 has it's own bathroom with shower. The other bathroom is located near all three bedrooms. The resident bathrooms were
observed to have the proper fixtures, grab bars, and non-skid mats. The hot water in the resident bathrooms measured at 112.0 and 112.4 degrees.

SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have functional auditory alarms when the doors open. The backyard of the facility is large enough to hold outdoor activities. The backyard is furnished with an umbrella, table and appropriate number of chairs. LPA observed a locked/fenced swimming pool and jacuzzi in the backyard. A locked shed was also observed in the side yard.

Garage: Facility has a detached garage, which will mainly be used as storage. Laundry machines, detergents and chemicals were observed locked in the detached garage, inaccessible to residents.

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 will be provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC809 (FAS) - (06/04)
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