195850162-5-15-2022-29-AS-ECAS-CEG2WS-20220515174602

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850162
Report Date: 05/15/2022
Date Signed: 05/15/2022 05:47:26 PM

Document Has Been Signed on 05/15/2022 05:47 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. #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:	05/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	MAKHTESYAN, DIANA		TIME COMPLETED:	05:45 PM

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Licensing Program Analyst’s (LPA) Elsie Campos and Ashely Smith arrived at the facility to conduct a required annual visit. This annual had a specific emphasis on infection control practices and procedures. The LPA’s met with Licensee Diana Makhtesyan and explained the reason for the visit.

During today’s visit, the LPAs discussed the current status of the license. The Licensee explained that because they would be out of town through the end of June, they thought it would be best to not accept residents until they are fully staffed. The Licensee stated that there were no residents, staff, or tenants residing at this location at this time. The Licensee admitted that they did not have an Administrator at this time. The LPAs reminded the Licensee that as the location is currently licensed, the Licensee was required to have a designee and/or Administrator on file. The Licensee stated that they would communicate the point of contact to the Department within the next 24 hours.

The LPA’s toured the physical plant areas inside and outside to ensure there are no health and safety hazards and to verify that the facility is in compliance with Title 22 Regulations.

BEDROOMS: The LPAs observed the bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There are 4 bedrooms for resident use and 1 bedroom room for staff use. The LPAs did not observe any clothing or personal items to indicate that any persons were currently residing in the facility.

KITCHEN: At the time of the visit, appliances were observed to be in good repair and operable. Although the facility currently does not have residents, the LPAs observed a sufficient supply of nonperishable food and frozen goods. Food was observed to be of quality and in good condition. Knives are stored inaccessible in a cabinet.

Continued on LIC 809-C

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2022

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: COMFORT ELDERLY CARE	FACILITY NUMBER: 195850162
	VISIT DATE: 05/15/2022

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RESTROOMS: Restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. The LPAs observed paper towels and soap. The LPAs observed the appropriate hand-washing signs in the restrooms.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. All exits have functioning auditory devices. The fire extinguisher was observed to be full. There was a screened fireplace in the living room. The LPA observed all the required postings in the dining area. Files are kept locked in a cabinet in the dining room. The LPAs observed that the Licensee kept record of staff and resident files. There were no medications observed at the facility.

BACKYARD: The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted.

INFECTION CONTROL: Upon entry, the facility had a central entry point for symptom screening, temperature checks, and sanitation station. There was hand sanitizer throughout the facility. There was 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 facility does not have a confirmed case of COVID-19 at this time. The LPAs reminded the Licensee that certain protocols would need to be in place regarding vaccination requirements, visitation, and testing protocol.

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: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2022

LIC809 (FAS) - (06/04)

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