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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850327
Report Date: 06/21/2024
Date Signed: 06/21/2024 12:52:44 PM

Document Has Been Signed on 06/21/2024 12:52 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:FARMDALE VILLA, INC.FACILITY NUMBER:
195850327
ADMINISTRATOR/
DIRECTOR:
PARANDZEM KONSTANYANFACILITY TYPE:
735
ADDRESS:6237 FARMDALE AVENUETELEPHONE:
(818) 620-0955
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 6CENSUS: 0DATE:
06/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Yuliya Asatryan, Co-LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and met with Yuliya Asatryan, Co-Licensee. The reason for today's visit was provided.

The facility is a single storey family home consisting of a living room, family room, dining room, kitchen, 5 bedrooms, 2 bathrooms and a storage room. The facility is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN. Bedroom #3 is designated for bedridden use.

The facility is in the process of being vendorized by the North Los Angeles County Regional Center and as of today's visit, has not accepted any clients in the home.

All 12 domains were reviewed on today' visit. Since the facility has no staff or clients in care, there were no files to review. The following was observed:
  • The living room, dining room, family room, kitchen, bedrooms, bathrooms were appropriately furnished and equipped as observed during the Pre-licensing visit conducted on 6/2/23.
  • Required bed linens were observed.
  • Water temperature was tested in front bathroom and it read 116.4 degrees and the back bathroom read 112.20 degrees Fahrenheit.
  • Smoke/Carbon monoxide combination detectors were tested and were operational.
  • Non-perishable foods that met Title 22 requirements were observed. As previously advised during the Pre-licensing visit on 6/2/23, Licensee will purchase the required perishable foods prior to accepting a resident.
No deficiencies were cited on today's visit.
Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2024
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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