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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850194
Report Date: 08/20/2021
Date Signed: 08/20/2021 11:46:39 AM

Document Has Been Signed on 08/20/2021 11:46 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:DEPENDABLE OVERNIGHT CARE, INC.FACILITY NUMBER:
195850194
ADMINISTRATOR:GALADJIAN, ALISAFACILITY TYPE:
740
ADDRESS:7356 LEESCOTT AVE.TELEPHONE:
(626) 517-3710
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 6CENSUS: 0DATE:
08/20/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Anna Hayrapeteyn TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Brian Balisi conducted a Pre-licensing visit to the above facility. LPAs met with Administrator Anna Hayrapeteyn and explained the reason for the visit.

At 10:00am LPA toured the physical plant conducted physical plant along with Administrator. LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. LPA observed Fire extinguishers to be purchased in July 2021. Smoke detectors and Carbon Monoxide detectors appeared to function properly during time of visit

Facility is a single-story residence and consists of a total of four (4) bedrooms and three (3) bathrooms. Fire clearance was approved on 7/20/2021 for four (4) non-ambulatory residents, one (1) ambulatory and one (1) bedridden. Fire extinguishers were observed to be fully charged from 6/07/2021. During physical plant tour LPAs observed the required postings throughout the facility.

Kitchen: The kitchen appeared to be clean at this time and the appliances and fixtures functional during the time of visit. LPAs observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects are stored in a cabinet in the kitchen to the right of the refrigerator. Medications are planned to be kept in this cabinet as well. No cleaning supplies or toxins will be kept under the sink. To the right of the kitchen was an empty room planned to be used for an office.

Continued on 809-C
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2021
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: DEPENDABLE OVERNIGHT CARE, INC.
FACILITY NUMBER: 195850194
VISIT DATE: 08/20/2021
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Continued from 809

Bedrooms: The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets.

Bathrooms: LPAs observed all bathrooms were clean, properly supplied and had functional fixtures. LPAs observed all bathrooms to have grab bars and non-skid mats. The hot water was measured in each bathroom between 105 - 111 degrees Fahrenheit.

Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Planned activities and games were on display on coffee table in living room area.

Outdoor Area: There was a shaded area with sufficient room for activities. There are no bodies of water on the premises. There is one fenced gate that self-latches with clear passageways for emergency exit use. Garage was accessible from the exterior. LPA observed garage to store washer and dryer as well as multple medical items and PPE. PPE supply appeared to be sufficient at this time.

Comp III was completed in conjunction with the visit.

Pursuant to Title 22, Division 6, facility observed to be compliant with regulation. No corrections needed at this time. A copy of this report will be forwarded to the application specialist with LPA's recommendation for licensure. An exit interview was conducted with Administrator, and a hard copy was provided via email.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
LIC809 (FAS) - (06/04)
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