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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191222081
Report Date: 06/11/2021
Date Signed: 06/13/2021 09:06:49 PM

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:ARARAT HOME OF LOS ANGELESFACILITY NUMBER:
191222081
ADMINISTRATOR:RITA NORAVIANFACILITY TYPE:
741
ADDRESS:15105 MISSION HILLS RD.TELEPHONE:
(818) 365-3000
CITY:MISSION HILLSSTATE: CAZIP CODE:
91345
CAPACITY:186CENSUS: 77DATE:
06/11/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Rita NoravianTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Yelena Avetisyan conducted an unannounced Required One (1) year - Infection Control inspection to the facility. Upon arrival LPA met with administrator Rita Noravian.
The facility submitted a mitigation plan which was reviewed and approved by the department on 4/22/2021. On 5/27/2021 the licensee received and Infection Control Inspection visit from CDPH. Copy of the report was provided to the LPA.

LPA conducted a tour of the physical plant and the following was noted:
There is only one entrance being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing mask upon entrance and during visit.

While conducting a tour of the physical plant LPA observed signs to wear a mask and other Covid 19 prevention protocol signs were posted throughout the facility on all 3 floors as well as hand washing, cough etiquette, physical distancing and other necessary signs. The facility has a designated visitors' area near the entryway. Visitations are also allowed in resident rooms because all residents are in currently in private rooms. Proper cleaning and disinfecting is completed after every visit. LPA observed sufficient stock of PPE and cleaning supplies which are kept in designated storage rooms that are easily accessible by staff.

Also during the visit LPA conducted review of the licensee Daily employee, resident and visitor symptom screening log, Daily cleaning schedule log for all departments. Additionally LPA conducted review of COVID 19 related training provided to all staff.

The licensee/administrator and staff are complying with all of the infection control protocols at this time
Exit interview conducted and copy of report emailed.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Yelena AvetisyanTELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021
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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