<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850162
Report Date: 12/23/2021
Date Signed: 12/23/2021 09:53:45 AM

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 CAREFACILITY NUMBER:
195850162
ADMINISTRATOR:MAKHTESYAN, DIANAFACILITY TYPE:
740
ADDRESS:22806 CALIFA STREETTELEPHONE:
(818) 602-1622
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 4DATE:
12/23/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Michael Tolentino, StaffTIME COMPLETED:
09:55 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) Salia Walker conducted an unannounced Plan of Correction (POC) visit to follow up regarding the plan of corrections that were due for submission to CCL by 12/11/21. The LPA met with staff Michael Tolentino at 8:39 a.m., and explained the reason for the visit. During today’s visit, the LPA conducted a physical plant tour at 8:42 a.m., to ensure there are no health and safety hazards.

On 12/2/2021, LPAs Salia Walker and Elsie Campos conducted an unannounced initial 10-day complaint inspection for complaint control # 29-AS-20211123163312. During the review, the LPAs observed six (6) cans of Pork and Beans, which contains 3.5 servings per can, six (6) cans of kidney beans, which contains 3.5 servings per can, and two (2) medium sized cans of Sun Vista pinto beans which contains 3.5 servings per can and four (4) cans total of various types of Vienna sausage, with approximately 2 servings per can. There were approximately four (4) cans of Chunky Chicken Noodle soup, which contains two (2) servings per can. There were four (4) cans of tomato sauce and there were ten (10) cans of tomato soup concentrate; however, the facility had no bottles of water available to add to the concentrate at the time, should the soup be needed during an emergency and the facility water was shut off. There was no evidence of any canned fruit or a variety of canned vegetables to help provide a balanced diet as required per the ‘Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. Regarding the perishable food supply, there was a sufficient supply of frozen meat; however, the fresh vegetables red bell peppers, and roman tomatoes were moldy and had to be discarded and there were no frozen vegetables, no fresh fruit or frozen fruit during the initial visit. The facility had a census of four (4) residents on 12/2/2021 and two (2) staff; therefore, there should be a minimum of two cans of vegetables for lunch and two cans of vegetables for dinner per day, which is four cans of vegetables per day times seven (7) days, which would equal twenty-eight (28) cans of vegetables minimum.

Continue on LIC809C..
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: 12/23/2021
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
26
27
28
29
30
31
32
There should also be two cans of fruit for breakfast, for lunch and for dinner, which equals six (6) cans per day times seven (7) days, equals forty-two (42) cans of fruit; and, there is currently only four cans of Vienna sausage, which would only serve 1.2 meals of protein. The facility should have a protein source available, whether it be canned tuna, salmon, corned beef, chicken, etc. so there is a variety of protein; and, there should be enough for at least two meals per day times seven (7) days. Most facilities cook their meals with fresh/frozen food and the seven (7) day canned food is only rotated into the menu prior to expiration date and replaced immediately so that there is always a sufficient amount of non-perishable food on the premises in the event of an emergency where the facility may not have gas, water or electricity. Staff interviews revealed that a grocery list is given to the administrator of what is needed for the facility, and someone delivers the groceries. According to staff, deliveries are made ‘about every two (2) weeks and more frequent if anything is needed.’ It must be expressed that the facility is required to maintain on a daily basis, two (2) days-worth of perishable food and seven (7) days-worth of non-perishable food on a daily basis, not once every two (2) weeks. The LPAs interviewed the facility residents regarding their meals. Interview with residents revealed that resident ‘usually buy their own snacks,’ and ‘staff share their snacks.’

On 12/10/2021, LPA Salia Walker conducted a subsequent complaint visit to deliver the investigation findings for complaint control # 29-AS-20211123163312; where the following deficiencies were cited, and a civil penalty were issued for a Repeat Violation. At 1:53 p.m., the LPA observed the facility did not contain an adequate supply of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. The LPA also did not observe any snacks for residents in care. The LPA advised the Designee, the facility residents are to have in-between meal snacks, unless stated otherwise by a physician. The Designee acknowledged understanding, and stated the administrator will be given an additional list of items to purchase for the facility which will include snacks. At approximately 1:50 p.m., the LPA spoke with Administrator Naira Paroyan through the Designee’s telephone, to advise that the facility has insufficient food supplies. The Administrator stated she was ‘at work, and will go to the grocery store once [she’s] off.’ Record review revealed, that the facility was previously cited for the same violation section 87555(b)(26) on 11/8/2021. Therefore, civil penalties were assessed for a Repeat Violation on 12/10/21.

Continue on LIC 809C..
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 12/23/2021
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
26
27
28
29
30
31
32
The facility was also cited for section 87555(b)(5), and section 87555(b)(3). The plan of corrections agreed upon for citations section 87555(b)(26), 87555(b)(5), and 87555(b)(3) were to: 1. Submit a receipt showing the purchase of perishable and non-perishable food, including snacks, and 2. Submit a copy of the facility's Menu reflecting a months’ worth of meals. Including breakfast, lunch, and dinner. The Plan of corrections have not been met, as the administrator only submitted a copy of the facility's Menu reflecting a months’ worth of meals; Including breakfast, lunch, and dinner on 12/14/21 at 11:17 a.m. Therefore, Civil Penalties are being assessed.
From 8:52 a.m. until 9:07 a.m., LPA Walker contacted administrator Naira Paroyan via telephone to inform her of civil penalties being assessed for failure to submit plan of corrections cited originally on 12/10/2021. The Administrator was also advised, $100 per day will continue to accrue until the Plan of Corrections have been cleared.
Pursuant to Title 22 California Code of Regulations, Civil Penalties were assessed for Failure to Correct. $100 per day will continue to accrue until the Plan of Corrections have been cleared.
Exit interview conducted, today's reports and appeal rights were reviewed and issued.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3