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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603543
Report Date: 05/17/2024
Date Signed: 05/17/2024 12:23:39 PM

Document Has Been Signed on 05/17/2024 12:23 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:GLENOAKS SENIOR GARDENFACILITY NUMBER:
198603543
ADMINISTRATOR/
DIRECTOR:		TEKEIAN, DIANAFACILITY TYPE:
740
ADDRESS:834 E GLENOAKS BLVDTELEPHONE:
(818) 726-4871
CITY:GLENDALESTATE: CAZIP CODE:
91207
CAPACITY: 5CENSUS: 0DATE:
05/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Hasmik TekeianTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Abeye Duguma met with Hasmik Tekeian for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at 09:10 AM and the following was noted:

There is one entrance being utilized at the facility. The facility has a total of three (03) bedrooms and two (02) bathrooms. The facility is fire cleared for five (05) non-ambulatory. The facility is currently occupying zero (00) residents.

The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for storage. Laundry detergents, cleaning agents and other toxins are locked away.

Food storage and preparation areas are clean and inaccessible to pests.

The living and dining room are neat and clean. The facility maintains a comfortable temperature at 69°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located in the living room and observed to be fully charged.

(continued on LIC 809-C)

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2024
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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLENOAKS SENIOR GARDEN
FACILITY NUMBER: 198603543
VISIT DATE: 05/17/2024
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The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 121.3°F. There was enough clean linen available in the cabinets. LPA observed first aid kit.

No health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024
LIC809 (FAS) - (06/04)
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