197610752-7-14-2025-31-AS-ERIS-DJKQDF-20250714120439

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610752
Report Date: 07/14/2025
Date Signed: 07/14/2025 12:05:08 PM

Document Has Been Signed on 07/14/2025 12:05 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	COMFORT OF YOUR HOME		FACILITY NUMBER:	197610752
ADMINISTRATOR/ DIRECTOR:	MANUKYAN, KRISTINE		FACILITY TYPE:	740
ADDRESS:	3761 SPICE STREET		TELEPHONE:	(626) 420-0808
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY: 6		CENSUS: 0	DATE:	07/14/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Applicant Romik Mkrtchyan and the administrator Kristine Manukyan		TIME VISIT/ INSPECTION COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Evelin Rios conducted a Pre-Licensing Inspection with the applicant representative, Romik Mkrtchyan and the administrator Kristine Manukyan. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on 01/07/2025. A fire clearance was approved on 01/28/2025 for five (05) non-ambulatory residents and one (01) bedridden resident for a total capacity of six (06). At entry LPA observed appropriate postings and a sign in area for visitors with hand sanitizer available. A tour of the physical plant was initiated at approximately 9:45 a.m., and the following was observed: KITCHEN: The kitchen is equipped with a refrigerator, microwave, stove/oven and dishwasher. There is a sufficient supply of seven day non-perishable food items. Applicant has a sufficient amount of tableware, dishes and utensils to accommodate the capacity of six (6) residents. Knives and sharps were observed locked in lock box on the kitchen counter. COMMON AREAS: These included the living room and dining room. The living room is furnished with one couch, one recliner and one television. There is a fireplace that is properly screened. The dining room table is large enough to seat the capacity of the facility. Floors and furniture were observed to be in good repair. Entry and exits were clear of obstruction. The smoke alarms and carbon monoxide detector are dual and inter-connected. The facility is equipped with two (02) fire doors that closed automatically when the smoke detector was tested at 10:12 a.m. The fire extinguisher is located in the kitchen and was observed fully charged with purchase date 12/19/2024.

NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/14/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: COMFORT OF YOUR HOME	FACILITY NUMBER: 197610752
	VISIT DATE: 07/14/2025

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BATHROOMS: The facility has three (3) bathrooms. Two (2) bathrooms are accessible to residents and visitors and the third bathrooms is located in the staff bedroom. Resident bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water temperature was measured in both resident bathrooms and they read between 113.5 and 120 degrees Fahrenheit, within regulation.

BEDROOMS: There are five (5) bedrooms total. Four (04) are designated for residents. Per STD 850, Bedroom #5 has bedridden fire clearance. Bedrooms #1 and #2 are shared. The applicant furnished the resident bedrooms with beds, night stand, foldable chairs, dressers, and bedding. The bedrooms have sufficient lighting and closet space. Facility windows and screens were observed in good repair.

LAUNDRY: The washer and dryer is located in a locked laundry room. In the laundry room the facility stores detergents and cleaning supplies.

GARAGE: The garage is attached to the house. The door leading to the garage will be maintained locked. The garage stores facility's overflow of items and emergency food and water.

OFFICE/STAFF WORKSTATION: Staff office is located by the kitchen, resident and staff records will be kept in a locked cabinet. Centrally stored medications, first aid kit and manual will be kept locked in cabinet.

SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alarms when the doors open. The backyard of the facility has a patio and appropriate backyard furniture to accommodate the six (6) residents. The facility's backyard has sufficient space for outdoor activities. There are no bodies of water. There is shed that will be locked for gardening tools.

The applicant and administrator completed component III. Pre-Licensing is complete and this facility has no deficiencies. This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. Exit interview was conducted with administrator. A copy of this report was signed and delivered.

NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/14/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025

LIC809 (FAS) - (06/04)

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