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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603386
Report Date: 04/03/2025
Date Signed: 04/03/2025 03:48:15 PM

Document Has Been Signed on 04/03/2025 03:48 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:ALAMEDA VILLAFACILITY NUMBER:
198603386
ADMINISTRATOR/
DIRECTOR:		LEKHLYAN, CHRISTINEFACILITY TYPE:
740
ADDRESS:1433 E. ALAMEDA AVETELEPHONE:
(818) 331-6331
CITY:BURBANKSTATE: CAZIP CODE:
91501
CAPACITY: 6CENSUS: 1DATE:
04/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Lena Badalyan - CaregiverTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced Annual Required visit and inspection of the facility. Upon arrival at 11:15 am, LPA met with Lena Badalyan/Caregiver and explained the purpose of the visit. LPA telephoned Administrator/Christine Lekhlyan, who designated Lena Badalyan to sign the report. LPA asked for copies of staff and resident rosters and files.The facility is licensed to serve six (6) non-ambulatory residents and approved for six (6) hospice waivers. Current census is one (1); the resident receives services from the Frank D. Lanterman Regional Center.

At 11:45 am, with the assistance of staff, LPA toured the physical plant area inside and outside to ensure there are no health and safety hazards. Mandated postings were observed by the entry door and in the office area. Smoke alarms and carbon monoxide detectors are interconnected and were tested to be functioning properly. There were two (2) fire extinguishers, both purchased on 12/16/2024, one in the kitchen and one by the rear exit door. There are two (2) exits leading to the backyard, the main entry door is used as emergency exit. All exits were equipped with functional alarms and were free on obstruction.

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NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2025
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ALAMEDA VILLA
FACILITY NUMBER: 198603386
VISIT DATE: 04/03/2025
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Common Areas: These included separate living room and dining area, located near the kitchen. The common areas were properly furnished with ample chairs/sofas for six (6) residents and staff. LPA observed a gaming area in the living room, along with a television set. Facility offers cable, internet and telephone for resident use.

Kitchen: The kitchen is equipped with a refrigerator, stove/oven, dishwasher, microwave. All appliances and fixtures were observed to be clean and in functional condition. LPA found sufficient supply of perishable foods for two (2) days and non-perishable foods for seven (7) days. Knives and sharp objects were stored in a locked drawer in the kitchen. Properly labeled medications were locked in a kitchen cabinet. First Aid Kit with First Aid Manual were observed in a locked kitchen cabinet as well. The kitchen cabinets were observed to have ample dishes and cook ware. Chemicals and detergents were locked in a cabinet underneath the kitchen sink.

Bathrooms: There are three (3) bathrooms designated for residents' use and one (1) bathroom for staff use. All bathrooms were sanitary and had the required grab bars and non-skid mats and functional fixtures. Hot water temperature was measured at 113.4 - 113.9 degrees Fahrenheit.

Bedrooms: There were six (6) private bedrooms designated for residents' use and one (1) for night staff. All bedrooms in use by residents were properly furnished with appropriate beddings, chairs, linens and sufficient lighting. Bedroom #2 has a non-functional fireplace. All bedrooms were observed to be clean, sanitary, with ample supply of linens.

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NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
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: ALAMEDA VILLA
FACILITY NUMBER: 198603386
VISIT DATE: 04/03/2025
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Surrounding Grounds: The backyard was large enough for activities and included appropriate furniture with ample seating for six (6) residents. The outdoor area was free of hazards and obstructions; no body of water was observed. The side exit door was observed to be unlocked from inside. The detached garage is currently used as office space. LPA observed all resident and staff files locked in a cabinet in the office area. Laundry room is adjacent to the garage/office and was kept locked.

Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms.

Staff Files: LPA conducted a file review of staff records to ensure forms and training certificates are up to date and compliant with licensing forms.

Medications: Medication and medication records were reviewed for proper documentation. LPA counted the medications and ensured proper dosage were given to the resident.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit.

Exit Interview Conducted / A Copy of the Report provided to the designee staff.

NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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