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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850340
Report Date: 06/02/2023
Date Signed: 06/02/2023 12:06:21 PM

Document Has Been Signed on 06/02/2023 12:06 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:HARMONY WELLNESS & CAREFACILITY NUMBER:
195850340
ADMINISTRATOR:ZARGERY,ZOHRABFACILITY TYPE:
735
ADDRESS:14632 COHASSET STREETTELEPHONE:
(818) 640-3369
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 4CENSUS: 0DATE:
06/02/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Zohrab Zargery, ApplicantTIME COMPLETED:
12:15 PM
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Licensing Program Analyst(LPA) Christine Yee conducted a subsequent Pre-Licensing Visit to verify that the corrections noted on the initial Pre-Licensing visit conducted on 5/10/23 were completed and to also conduct Component III with Zohrab Zargery, Applicant

The following corrections were observed on today's visit:
  • the fireplace was covered with a screwed on metal screen
  • Perishable and non-perishable food were purchased but not in quantities to meet the 2 days for perishables and 7 days for non-perishables as required by Title 22 for 4 residents. Per Applicant, he will purchase more perishable food prior to accepting the first client. A receipt of additional non-perishable food purchased will be faxed to LPA Yee by 6/9/23.
  • Motion triggered night lights were observed in the hallway
  • Personal items kept in the residents' rooms were removed
  • 2 extra sets of bed linens consisting of a fitted sheet, flat sheet and 2 pillow cases for each resident were observed.
  • 2 bath towels, 2 hand towels and 2 face towels were observed for each resident
  • 2 blankets for each resident were observed
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: HARMONY WELLNESS & CARE
FACILITY NUMBER: 195850340
VISIT DATE: 06/02/2023
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  • A complete comforter set in addition to the one on the bed was also purchased for each resident.
  • Hygiene products were observed on the dresser
  • The water tested in the common bedroom read 115.1 degrees Fahrenheit.
  • The front and backyard were observed to be clean and all the discarded items were removed.
  • the locks on the side gates located on both sides of the home have been replaced with latches.


Note: The facility telephone number - (818)453-8612- obtained during the initial Prelicensing visit was tested and was operational.

Component III was conducted with Zhorab Zargery

No additional deficiencies were observed on today's visit, to impede the clearance of the facility for licensure.

Exit interview was conducted and a 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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