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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850149
Report Date: 07/17/2024
Date Signed: 07/17/2024 02:41:55 PM

Document Has Been Signed on 07/17/2024 02:41 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:COZY ADULT CARE INC.FACILITY NUMBER:
195850149
ADMINISTRATOR/
DIRECTOR:		PUNO, MICHELLEFACILITY TYPE:
735
ADDRESS:13554 CANTARA ST.TELEPHONE:
(323) 348-8522
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY: 4CENSUS: 0DATE:
07/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Vardan Adzemian, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Emily Peraldi and Erica Mosley arrived at the facility unannounced to conduct a required annual visit. At 1:04 p.m., the LPA met with the Licensee and explained the reason for the visit.

Currently the facility has zero (0) clients and is awaiting to be vendored through North Los Angeles County Regional Center (NLACRC). At 1:26 p.m., the LPAs, along with the Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards.

KITCHEN: The LPAs observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 1:30 p.m., hot water measured at 107.0-degree Fahrenheit. Medications and first aid kits will be located in a locked cabinet near the kitchen. BEDROOMS: The facility is a single-story residential home with four (4) bedrooms for client use and two (2) restrooms. The LPA observed client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restroom is relatively clean and sanitary and in operating condition. At 1:38 p.m., hot water measured at 105.4-degree Fahrenheit. COMMON AREAS: The LPAs observed common area to be relatively clean and properly furnished. The LPAs observed the fire extinguisher to be fully charged and purchased on 06/12/2024. At 1:38 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. The laundry units are located in the hallway behind the kitchen area. OUTDOOR SPACE: The LPAs observed the back patio which has a covered outdoor area for client use. There is a gate on the side of the house designated for an emergency exit. The LPAs observed cameras at the exterior perimeter of the facility. There are no bodies of water on the premises. The property is connected to a city approved an Accessory Dwelling Unit (ADU). The clients will not have access to the ADU.
No deficiencies were observed at this time. Exit interview conducted and a copy of the report was issued.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
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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