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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850327
Report Date: 06/02/2023
Date Signed: 06/02/2023 03:15:41 PM

Document Has Been Signed on 06/02/2023 03:15 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 NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:FARMDALE VILLA, INC.FACILITY NUMBER:
195850327
ADMINISTRATOR:PARANDZEM KONSTANYANFACILITY TYPE:
735
ADDRESS:6237 FARMDALE AVENUETELEPHONE:
(818) 620-0955
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 6CENSUS: 0DATE:
06/02/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Parandzem Konstanyan, ApplicantTIME COMPLETED:
03:25 PM
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Licensing Program Analyst(LPA) Christine Yee conducted a subsequent announced Prelicensing visit to verify that the deficiencies observed during the initial visit conducted on 5/12/23 were corrected. LPA Yee met with Parandzem Konstanyan and Yuliya Asatryan, Applicants.

The following was observed on today's visit:
  • Non-perishable foods for 7 days were purchased and met Title 22 requirements. However, the required perishable foods for 2 days will be purchased prior to accepting the first client.
  • Extra sets of bed linens were observed in the office/storage room
  • Extra bath towels, hand towels and face towels were observed in the office/storage room
  • 3 mattress pads for bedroom #1 and #2 were observed in the office/storage room.
  • Dressers were observed in bedrooms #1, #2, #4 and #5
  • The curtain in bedroom #2 was changed to a shorter one
  • A first aid manual was observed in the kitchen


continued on LIC809-C
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2023
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
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: FARMDALE VILLA, INC.
FACILITY NUMBER: 195850327
VISIT DATE: 06/02/2023
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  • Cleaning solutions and rubbing alcohol were moved to under the locked kitchen sink and the laundry detergent was relocated to a locked kitchen cabinet
  • Items such as a table, water cooler, scratching post, water bowl were relocated.
  • The front yard and backyard was observed to be clean and all unused items were put away.
  • Trash cans were all tightly sealed.

Note: Bedroom #1 previously set up for double occupancy on the initial Prelicensing visit has been switched to single occupancy. Bedroom #5 has been switched to double occupancy. Both rooms have the required Title 22 furniture.

Based on today's visit, LPA did not observe any additional deficiencies to impede the licensure of the facility.


Exit interview was conducted and copy of the report was provided.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023
LIC809 (FAS) - (06/04)
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