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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603456
Report Date: 05/10/2022
Date Signed: 05/10/2022 11:37:44 AM

Document Has Been Signed on 05/10/2022 11:37 AM - 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:LOVE AND CARE HOMEFACILITY NUMBER:
198603456
ADMINISTRATOR:MELKONIAN, ELINAFACILITY TYPE:
740
ADDRESS:2104 N. MAPLE STREETTELEPHONE:
(818) 216-8361
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 6CENSUS: 0DATE:
05/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Elina MelkonianTIME COMPLETED:
11:45 AM
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Licensing Program Analysts (LPA) Jewel Baptiste conducted an unannounced visit for the purpose of conducting the required annual inspection. On today's visit LPA met administrator George Agopian who stated the facility do not have any residents at this time. The administrator stated the facility is not operating because they are in the final process with Frank D. Lanterman Regional Center, and it will take a couple of months for the regional center to provide residents. LPA and administrator toured the facility together.

Facility is licensed to serve 6 clients 60 years and over. 6 of which shall be non- ambulatory. Hospice wavier approved for 6. The facility is a single-story building in a residential area, with a commercial kitchen, dining room, living room, 6 bedrooms, 2 bathroom, backyard with a shed and a garage. Facility has a fire sprinkler system throughout the facility. Administrator certificate observed for George Agopian # 6045376740, expires 8/31/2023. Administrator certificate was observed for Elina Melkonian #6045252740 expires 8/31/2023.

LPAs discussed infection control practices with administrator, toured the facility inside and out, reviewed food supply. There are no staff files, and resident medications to review due to not accepting residents currently.

Report continued on 809c

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2022
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: LOVE AND CARE HOME
FACILITY NUMBER: 198603456
VISIT DATE: 05/10/2022
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Bedrooms 1-6 have the required furniture including bedframes, dressers, lamps, and chairs. Beds have the required linen and the linen is in good condition. LPA toured the kitchen and observed the facility do not have 7 days of perishables and 2 days nonperishable due to the facility not accepting residents at this time. Fire extinguisher was also observed in fully charged and located in the kitchen. Passageways and exits are free of obstruction. The front and backyard are well maintained. The Shed has emergency food supplies and the facility plan on buying more when they received their first resident. Bathrooms 1-2 are clean and have the required grab bars and skid matts. The hot water temperature measured at 109.1-114.1 degrees F. The facility temperature at the time the visit was comfortable. There is sufficient lighting throughout the facility. There are smoke detectors located throughout the facility, tested and operational. The facility also has fire doors that were tested in working condition. Carbon monoxide detector was also observed, tested and operational. Infection control signs were not observed throughout the facility, Administrator purchased signs during the visit.

An action plan will be submitted to Licensing regarding how the licensee plan to stay operating, their process with the regional center and when they will start to receive residents by 5/14/22.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were Technical Advisory observed during the visit. Exit interview held and a copy of the report was provided to administrator.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
LIC809 (FAS) - (06/04)
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