195850155-8-31-2023-29-AS-SURA-CV8M72-20230831092045

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850155
Report Date: 08/30/2023
Date Signed: 08/31/2023 09:21:28 AM

Document Has Been Signed on 08/31/2023 09:21 AM - 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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	HAPPY DAYS FAMILY CARE		FACILITY NUMBER:	195850155
ADMINISTRATOR:	BADALYAN, MARY		FACILITY TYPE:	740
ADDRESS:	7060 MORSE AVE		TELEPHONE:	(818) 915-8593
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	6	CENSUS: 2	DATE:	08/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Mary Badalyan		TIME COMPLETED:	03:30 PM

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Licensing Program Analyst (LPA) Sandra Urena arrived at the facility at 10:15 a.m., unannounced to conduct a required annual inspection. LPA Urena met with Administrator Mary Badalyan and explained the reason for the visit.

From 10:25 a.m. to 10:55 a.m., the LPA and the administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations.

KITCHEN: The LPA, and the administrator toured the kitchen and observed the following: Kitchen knives are stored in a locked cabinet. Kitchen appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods, fresh vegetables and fruit. Emergency food supply is adequate for six residents and two staff. The fire extinguisher mounted in the kitchen area, did not have a date of purchase, nor date of service, posing a potential danger to residents in care.

BATHROOM: Bathrooms were observed to be clean, shower area was in clean condition with grab bars and non-skid mat available. Paper towels were available for drying hands. Hand washing sign was displayed.

Continues on LIC809 C...

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HAPPY DAYS FAMILY CARE	FACILITY NUMBER: 195850155
	VISIT DATE: 08/30/2023

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BEDROOM: The LPA and the administrator toured the bedrooms and observed the following: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The facility is licensed for one (1) ambulatory resident, four (4) non-ambulatory residents, and one (1) bedridden resident (in bedroom #4) for a total capacity of six (6) residents. Bedroom #4 has been cleared by the Fire department to be used for the one (1) bedridden resident.

COMMON AREAS: The living room, and dining areas are clean and properly furnished. The walls, ceiling, and floors were found to be clean, and in good condition.

OOTDOOR AREA: The LPA, and administrator observed the backyard, which has a covered outdoor area for resident use. There is a self-latching gate on the side of the house designated for an emergency exit. The exterior passageways were clean and clear of any obstructions. A pool was observed in the backyard surrounded by a fence and with a padlock. Bodies of water were observed to be inaccessible to residents.

RECORDS: Records review began at 11:00 a.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order.

MEDICATIONS: Medications review began at 12:30 p.m. Medications are centrally stored and locked in a cabinet in the hallway; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review.

INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPAs discussed the new PIN changes regarding infection control.

The LPA obtained the following documents:

- LIC500 Personnel Report
- LIC9020 Client Roster

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC809 (FAS) - (06/04)

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