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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603495
Report Date: 09/10/2021
Date Signed: 09/10/2021 11:20:12 AM

Document Has Been Signed on 09/10/2021 11:20 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:AREGO HOME INCFACILITY NUMBER:
198603495
ADMINISTRATOR:MARKOSIAN, ARMENFACILITY TYPE:
740
ADDRESS:1017 WESTERN AVETELEPHONE:
(818) 913-1742
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY: 6CENSUS: 0DATE:
09/10/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Armen Markosian (Administrator)TIME COMPLETED:
11:30 AM
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Licensing Program Analysts (LPAs) Kruz Long conducted an announced visit to the facility for the purpose of a pre-licensing evaluation.

An application was received for Initial License #198603495 Residential Care Facility for the Elderly age range 60 and over. The requested capacity is for 6 only.

The facility is a single story house which consist of a living room, kitchen, dining area, 4 Resident bedrooms, 2 bathrooms and a laundry room. The resident bedrooms are spacious and will easily accommodate the resident's furnishings. The front yard contains a cover patio area. Passageways, walkways, driveway, and patios are free of obstructions. Front, back and side areas are free of hazards. All resident bedrooms contain beds, chairs, night stand, lamps in addition to overhead lighting. Bathrooms have a working toilet, wash basin, bathtub/stand up shower equipped with non-skid matts and grab bars. Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Emergency Phone Numbers, Exit Plan & Menu are posted & readily available for review. Fire Extinguisher located in the kitchen mounted to the wall. Telephone system is a land line located in the living room. Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked drawer in the kitchen. Smoke Detectors and Carbon monoxide detector are operational. Stove burners, oven, microwave, washer, and dryer working. There are two refrigerator in the kitchen. Toxins are stored and locked under the kitchen sink. Water Temperature measured within Title 22 guidelines in the kitchen. A first aid kit has been inspected and consist the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in the kitchen available for staff use but inaccessible to residents. Medications and records will be stored in a locked cabinet in the dining area. The facility has board games, books, and other recreational materials for the resident's use in the living room. There are no Pool/Jacuzzi & Pets on the premises. Fire Clearance was approved on 06/15/2021. All exit doors is equipped with an alert devise. Continue to LIC809C.........
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2021
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: AREGO HOME INC
FACILITY NUMBER: 198603495
VISIT DATE: 09/10/2021
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Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance.

During the pre-licensing inspection, LPA did not observe items which do not comply with applicable laws and regulations.

An exit interview was conducted and a copy of this report has been furnished to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
LIC809 (FAS) - (06/04)
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