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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603515
Report Date: 01/11/2022
Date Signed: 01/11/2022 01:05:03 PM

Document Has Been Signed on 01/11/2022 01:05 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:TOUCHING HEARTS BOARDING CAREFACILITY NUMBER:
198603515
ADMINISTRATOR:MKRTCHYAN, MARGARITAFACILITY TYPE:
740
ADDRESS:1010 LINDEN AVETELEPHONE:
(424) 216-0864
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY: 6CENSUS: 0DATE:
01/11/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Margarita Mkrtchyan, ApplicantTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted an announced visit to the facility on 1/11/2022 for purpose of a prelicensing evaluation. LPA met with Applicant, Margarita Mkrtchyan and her Consultant, Narine Mamyan.

An application was submitted to CCLD on 8/6/2021, for an initial license for a Resident Care Facility for the Elderly to serve the Elderly, 60 years and older. The requested capacity is for 6 residents, of which 5 may be Non-Ambulatory and 1 Bedridden. Component III was also completed during this visit.

LPA Chan toured the entire facility and observed the following:
* A single story home that consists of: 3 bedrooms, 2 bathrooms (1 for resident use and 1 for employee), living room with dining table, and kitchen. Bedroom #3 is the designated bedridden resident room which has a emergency exit with a ramp. The laundry room is located outside. Each exit area is equipped with a ramp. The fireplace in the living room is for decoration and not operational.
* The spacious outdoor area consists of a gazebo with a bench and table for residents use.
* Passageways and doors are not blocked and handrails are securely fastened.
* The bedrooms are equipped with the night stand, lamp, adequate closet space, and chair. LPA observed 2 beds in bedroom #1 and per applicant, she will provide beds to residents if they do not bring their own.
* Extra bath towels, hand towels, wash cloths, blankets, bed linens were observed.
* Knives and sharps are locked and stored in the kitchen cabinet. Disinfectants and cleaning solutions are locked under the kitchen sink. Additional supplies of cleaning solutions are stored in an outside storage cabinet.
* The kitchen area consists of a refrigerator, microwave, and stove which are functional. Sufficient dishes and
utensils were also observed.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2022
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: TOUCHING HEARTS BOARDING CARE
FACILITY NUMBER: 198603515
VISIT DATE: 01/11/2022
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* Facility has a supply of a week of non-perishable foods. Per applicant, the perishable items will be purchased prior to receiving first client.
* Emergency disaster plan, Personal Rights, and Complaint procedures, along with the post labor information
are posted in the living room.
* There are a total of 5 smoke with the carbon monoxide combination detectors at the facility. Each bedroom has the detector, one in the hallway, and one in the living room, and are all operational.
* The medications will be stored and locked in the kitchen cabinet.
* Staff and residents files will be maintained at the facility and will be secured in a locked safe.
* Adequate supplies of reading materials and games were observed.
* The facility phone number is (747) 477-1284.

Component III was conducted today and information was provided about how to operate the facility within substantial compliance.

During the inspection, the hot water temperature was not measured within the required range of 105-120 degree Fahrenheit. The item must be corrected and proof of correction shall be submitted to LPA Chan by 1/14/21.

An exit interview was conducted and a copy of this report has been furnished to the applicant.

Pre-Licensing is incomplete with a deficiency to be resolved by 1/14/21. A follow up Pre-licensure LIC809 will be generated upon resolution of the deficiency.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022
LIC809 (FAS) - (06/04)
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