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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850234
Report Date: 06/27/2024
Date Signed: 06/27/2024 06:22:02 PM

Document Has Been Signed on 06/27/2024 06:22 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:HELPING HANDS BOARDING CAREFACILITY NUMBER:
195850234
ADMINISTRATOR/
DIRECTOR:
ATANYAN, GRIGORFACILITY TYPE:
740
ADDRESS:8022 IRVINE AVENUETELEPHONE:
(818) 299-2258
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 6CENSUS: 5DATE:
06/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Ani PalezyanTIME VISIT/
INSPECTION COMPLETED:
06:35 PM
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 Analysts (LPAs) Angela Barutyan and Trevor Byrne along with Licensing Program Manager (LPM) KaSandra Lopez arrived at the facility unannounced to conduct a required annual visit at 1:25 PM. When the LPAs/LPM arrived they met with two staff members. Administrator Ani Palezyan arrived to the facility at 1:45 PM.

Beginning at 01:27 PM, the LPAs/LPM, along with Staff #1 (S1) toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

The fire extinguisher was fully charged and purchased on 12/22/2023. Hardwired combination smoke and carbon monoxide detectors and fire door were tested at 01:39 PM and all were functional at the time of the visit. No fire clearance concerns were observed.

KITCHEN/GARAGE: The LPAs/LPM observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Cleaning supplies and knives were observed in locked cabinets.



BEDROOMS: There are 3 (three) total bedrooms in the facility and no staff room. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. All exit doors had a functioning auditory device.

BATHROOMS: There are 2 (two) bathrooms for resident use. 1 (one) is a common restroom and the other 1 (one) is a shared resident restroom in bedroom #1. Restrooms were observed to be equipped with nonskid mats. Grab bars were observed in the bathrooms. The water temperature was measured in the shared bathroom and measured within the required range at 112.8 F at 01:44 PM.

Report Continued on LIC 809-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
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 8
Document Has Been Signed on 06/27/2024 06:22 PM - It Cannot Be Edited


Created By: Angela Barutyan On 06/27/2024 at 04:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HELPING HANDS BOARDING CARE

FACILITY NUMBER: 195850234

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 06/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87355(e)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in 1 (one) out of 4 (four) staff did not have proof of criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/27/2024
Plan of Correction
1
2
3
4
Staff left the premises during the inspection. Administrator stated staff member is not returning. Plan of correction (POC) is cleared.
Type A
Section Cited
CCR
87355(e)(3)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in 1 (one) out of 4 (four) staff did not have a transfer of criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2024
Plan of Correction
1
2
3
4
Administrator agrees to have S1 associated to the facility by 06/28/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kristin Heffernan
LICENSING EVALUATOR NAME:Angela Barutyan
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024


LIC809 (FAS) - (06/04)
Page: 2 of 8
Document Has Been Signed on 06/27/2024 06:22 PM - It Cannot Be Edited


Created By: Angela Barutyan On 06/27/2024 at 04:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HELPING HANDS BOARDING CARE

FACILITY NUMBER: 195850234

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 06/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87413(a)(1)
Personnel - Operations
(1) When regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in as there were no staff with evidence of training present when the LPAs/LPM arrived which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/12/2024
Plan of Correction
1
2
3
4
Administrator agrees to submit proof of staff training to CCL by 07/12/2024.
Type B
Section Cited
CCR
87412(g)
Personnel Records
(g) All personnel records shall be maintained at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in 1 (one) staff did not have a personnel file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/12/2024
Plan of Correction
1
2
3
4
Administrator agrees to have a complete facility file for S1 by 07/12/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kristin Heffernan
LICENSING EVALUATOR NAME:Angela Barutyan
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024


LIC809 (FAS) - (06/04)
Page: 3 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: HELPING HANDS BOARDING CARE
FACILITY NUMBER: 195850234
VISIT DATE: 06/27/2024
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
COMMON AREAS: This includes the living room and dining room areas. LPAs/LPM observed common area to be clean and properly furnished at the time of the visit. At 01:37 PM the supply closet in the dining room was observed to be unlocked and contained cleaning supplies and medications. Exit doors contain alarms and were functional at the time of the visit. LPAs/LPM observed video surveillance cameras in the common areas with an audio component. The administrator was advised that they are not allowed to have an audio component, therefore administrator agreed to remove the surveillance cameras. Medications and records were observed in locked cabinets in the living room area.

OUTDOOR SPACE: The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. There were no bodies of water on the premises. An outdoor shed was observed to be locked and inaccessible to residents.



MEDICATION REVIEW: LPAs/LPM were unable to conduct medication audit due to residents' medication not being stored on the Centrally Stored Medication and Destruction Record.
RECORD REVIEW: Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. Five resident files reviewed were found to be complete, although record review and an interview with the Administrator revealed Resident #1 (R1) needs assistance with all activities of daily living and does not have an approved exception on file. Staff record review revealed, S1 did not have a facility file and was not associated to the facility. The Administrator also did not have proof that Staff #2 (S2) was associated or had criminal record clearance. S2 left the premises after the LPAs/LPM arrived. Administrator's certificate was observed to be current with an expiration date of 01/24/2025.INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPAs reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency disaster drills are conducted quarterly, with the last drill conducted on 05/23/2024.

Administrator was advised that licensing fees are due today 06/27/2024 and was provided the PIN to pay the fees online.

Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiencies may result in civil penalties. Exit interview conducted, report issued, and appeal rights provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 06/27/2024 06:22 PM - It Cannot Be Edited


Created By: Angela Barutyan On 06/27/2024 at 05:07 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HELPING HANDS BOARDING CARE

FACILITY NUMBER: 195850234

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 06/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87615(a)(5)
87615 Prohibited Health Conditions
(a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly:
(5) Residents who depend on others to perform all activities of daily living for them as set forth in Section 87459, Functional Capabilities.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in 1 (one) out of 5 (five) residents (R1) depends on others to perform all activities of daily living and facility does not have an approved exception which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/05/2024
Plan of Correction
1
2
3
4
Administrator will submit an exception request for R1 by 07/05/2024.
Type A
Section Cited
CCR
87705(f)(2)
87705 Care of Persons with Dementia
(f) The following shall be stored inaccessible to residents with dementia:
(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.


This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above as an unlocked supply closet with cleaning supplies was observed in the common area which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/27/2024
Plan of Correction
1
2
3
4
S1 locked the supply closet and Administrator agreed to insure the door is locked at all times. POC is cleared.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kristin Heffernan
LICENSING EVALUATOR NAME:Angela Barutyan
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024


LIC809 (FAS) - (06/04)
Page: 7 of 8
Document Has Been Signed on 06/27/2024 06:22 PM - It Cannot Be Edited


Created By: Angela Barutyan On 06/27/2024 at 05:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HELPING HANDS BOARDING CARE

FACILITY NUMBER: 195850234

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 06/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(h)(6)
87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6)The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (A) The name of the resident for whom prescribed.
(B) The name of the prescribing physician. (C) The drug name, strength and quantity.
(D) The date filled. (E) The prescription number and the name of the issuing pharmacy.
(F) Instructions, if any, regarding control and custody of the medication
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 5 (five) out of 5 (five) resident medications were not stored on a Centrally Stored Medication and Destruction Record which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/05/2024
Plan of Correction
1
2
3
4
Administrator agrees to log all medications on the Centrally Stored Medication and Destruction Record and submit proof to CCL by 07/05/2024.
Type B
Section Cited
CCR
87468.1(a)(1)

87468.1 Personal Rights of Residents in All Facilities
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above as the common areas have surveillance cameras with an audio component which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/27/2024
Plan of Correction
1
2
3
4
Devices were removed during inspection. POC is cleared.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kristin Heffernan
LICENSING EVALUATOR NAME:Angela Barutyan
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024


LIC809 (FAS) - (06/04)
Page: 8 of 8