195850162-4-30-2021-29-AS-ARIN-C2KRL8-20210430130643

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850162
Report Date: 04/30/2021
Date Signed: 04/30/2021 01:07:56 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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	COMFORT ELDERLY CARE		FACILITY NUMBER:	195850162
ADMINISTRATOR:	MAKHTESYAN, DIANA		FACILITY TYPE:	740
ADDRESS:	22806 CALIFA STREET		TELEPHONE:	(818) 602-1622
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	6	CENSUS: 0	DATE:	04/30/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Diana Makhtesyan		TIME COMPLETED:	11:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Aja Richardson conducted a Prelicensed visit at 10 am and met with the Administrator and applicant Diana Makhtesyan. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s visit was conducted virtually via Facetime. This application is for a change of location for Residential Care Facility for the Elderly (RCFE) with a capacity of 6. Approved for 1 bedridden resident, 4 non ambulatory and 1 ambulatory resident. At 10 am, a tour of the physical plant was conducted. During the visit LPA observed the following: KITCHEN: The facility is equipped with a spacious kitchen that is supplied with adequate dining and cook ware. Appliances and fixtures are clean and functional. The kitchen trash can was equipped with a lid. BEDROOMS: There are (4) bedrooms for residents in care. Room 1 and 2 are private rooms and rooms 3 and 4 are shared rooms. Room 1 is cleared for ambulatory only, room 3 is cleared for bedridden. All other bedrooms are cleared for non ambulatory. There is a staff room that will be kept locked. All bedrooms were supplied with all required bedding and linens. There is sufficient lighting as well as closet and drawer space available. BATHROOMS: There are (2) full bathrooms. Bathrooms are equipped with toilet and shower grab bars. There is sufficient supplies of towels, paper goods and personal hygiene supplies. Hot water delivered at 110 degrees F and 108 degrees F.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja Richardson	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2021

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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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: COMFORT ELDERLY CARE	FACILITY NUMBER: 195850162
	VISIT DATE: 04/30/2021

NARRATIVE

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COMMON AREAS: These include a living space equipped with a television. There is a dedicated area for the posting of required documents in the dining area. Smoke detectors checked and is connected to carbon monoxide. Medication, resident and staff files are stored locked in dining area.

LAUNDRY ROOM: There is a laundry area equipped with washer and dryer in the attached garage. Detergents and cleaning supplies will be stored in locked cabinet in garage.

SURROUNDING GROUNDS: The property is equipped with fencing and gates . There is furniture appropriate for outdoor use including a covered patio providing shade.

At this time facility has passed prelicensing inspection,

Exit Interview Conducted. Report emailed to Administrator and hard copy signature requested.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja Richardson	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2021

LIC809 (FAS) - (06/04)

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