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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191222081
Report Date: 06/21/2022
Date Signed: 06/21/2022 04:22:31 PM


Document Has Been Signed on 06/21/2022 04:22 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: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: 81DATE:
06/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:RITA NORAVIAN, AdministratorTIME COMPLETED:
04:30 PM
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Licensing Program Analysts (LPAs) Tihesha “Lynn” Smith and Gary Tan arrived at the facility at 1:10 pm on 06/21/2022 to conduct an unannounced One (1) year Required Infection Control visit. LPAs meet with Administrator Rita Noravian and Resident Care Director Vicky Tumikyan and explained the purpose of this visit.

The facility has a mitigation and infection control plan on file.

A tour of the physical plant was conducted at 1:35 pm and the following was observed:



The facility has one main entrance being used, there are required Covid-19 prevention signage (hand washing, coughing etiquette, and physical distancing) posted. The PPE screening station is located on a table near the entrance equipped with sufficient PPE readily accessible, hand sanitizer, gloves, and sign in sheet at the time of 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 three (3) floors as well as hand washing, cough etiquette, and physical distancing signs. The facility has a designated visitors' area near the entryway and hospitality room on 1st floor. Proper cleaning and disinfecting completed after every visit.
The facility has multiple fire extinguishers located throughout the facility to all have a service tag dated 06/02/2022. The smoke detectors are tested monthly and based on LPAs review of the monthly inspection reports all detectors passed for all apartments.
Bedrooms: At 1:38 pm LPAs observed eight (8) random bedrooms that are equipped with private bathrooms. All bedrooms observed to be appropriately furnished with sufficient lighting. LPAs observed appropriately bed linen and comforters on all beds. All bedrooms observed to be clean and clear from obstruction. The facility has public bathrooms located throughout the facility for visitors.
(Cont. on 809C)
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha SmithTELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2022
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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ARARAT HOME OF LOS ANGELES
FACILITY NUMBER: 191222081
VISIT DATE: 06/21/2022
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(Cont from 809)

Bathrooms: At 1:38 pm LPAs observed eight (8) bathrooms located inside of resident’s rooms to be clean and clear from obstruction. LPAs observed appropriate grab bars in shower and toilet area or a commode with handles around the toilet area. Bathrooms are stocked and equipped with soap and paper towels. The water temperature measured in range of 108.1 between 119.8 degrees Fahrenheit.
Medications: : At 2:20 pm LPAs observed Doctors Clinic room on 2nd floor, to be storing medication carts. Medication carts and refrigerators used for medication and eyedrops were observed to be locked and inaccessible to residents. FIrst aid kits located in Doctors clinic and throughout facility.

Kitchen: At 2:30 pm LPAs observed the kitchen to be clean and free from obstruction and inaccessible to residents. Appliances observed to be in good repair and functioning. The facility has a sufficient 7 days perishable and 2 days non-perishable food.
Dining room/Resident Lounge/Common areas observed to be appropriately furnished with tables and chairs and adequate lighting. LPA observed the areas to be clean and free from debris.

No deficiencies cited, exit interview conducted, copy of report signed and issued.

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha SmithTELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
LIC809 (FAS) - (06/04)
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