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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850194
Report Date: 09/20/2022
Date Signed: 09/20/2022 03:33:17 PM

Document Has Been Signed on 09/20/2022 03:33 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:DEPENDABLE OVERNIGHT CARE, INC.FACILITY NUMBER:
195850194
ADMINISTRATOR:HAYRAPETYAN, ANNAFACILITY TYPE:
740
ADDRESS:7356 LEESCOTT AVE.TELEPHONE:
(626) 517-3710
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 6CENSUS: 6DATE:
09/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Anna Hayrapetyan - Administrator TIME COMPLETED:
03:45 PM
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At 12:30 PM., Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit. LPA was greeted and screened by staff Marivic Sidora. LPA met with Administrator Anna Hayrapeteyn and explained the reason for the visit. This annual had a specific emphasis on infection control practices and procedures.

At approximately 1pm, LPA toured the 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 September 2022. 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. During physical plant tour LPAs observed the required postings throughout the facility. At 1:30, LPA observed residents in their rooms either sleeping or watching television.

Kitchen: The kitchen appeared to be clean 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. No cleaning supplies or toxins are stored under the sink. Staff bedroom next to the kitchen was observed empty at this time.

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.

Continued on 809-C
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2022
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: DEPENDABLE OVERNIGHT CARE, INC.
FACILITY NUMBER: 195850194
VISIT DATE: 09/20/2022
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Continued from 809


Bathrooms: LPAs observed all bathrooms were clean, properly supplied and had functional fixtures. LPA observed all bathrooms to have grab bars and non-skid mats. The hot water was measured in each bathroom between 105 - 112 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. Medication cart by entry way was observed locked and inaccessible to residents in care.

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 it to store medical equipment, medical supplies, as well as emergency food.

 The LPA spoke with Anna regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. 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 isolate resident in bedroom #4 or #1  if the facility has a confirmed case of COVID-19. COVID-19 testing is conducted weekly if anyone shows any symptoms. The facility’s policies and procedures as it pertains to infection control are adequate at this time.

Exit interview conducted, report issued and sent via email. 
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022
LIC809 (FAS) - (06/04)
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