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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850340
Report Date: 06/25/2024
Date Signed: 06/25/2024 12:13:20 PM

Document Has Been Signed on 06/25/2024 12:13 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:HARMONY WELLNESS & CAREFACILITY NUMBER:
195850340
ADMINISTRATOR/
DIRECTOR:		ZARGERY,ZOHRABFACILITY TYPE:
735
ADDRESS:14632 COHASSET STREETTELEPHONE:
(818) 640-3369
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 4CENSUS: 0DATE:
06/25/2024
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Zohrab Zargery, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:20 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 Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and met with Zohrab Zargery, Administrator. The reason for today's visit was provided.

The facility is a single storey family home consisting of a living room, dining room, kitchen, laundry room, 4 bedrooms, 2 full bathrooms and a attached garage. The facility is fire cleared for 1 AMBULATORY and 3 NON-AMBULATORY clients. Bedroom #1 is designated for AMBULATORY use only.

The facility is in the process of being vendorized by the North Los Angeles County Regional Center and currently does not have any staff or clients in care as of today's visit. There were no client or staff files to review.

All 12 domains of the CARE Inspection Tool was reviewed on today's visit. A tour of the facility, inside and outside, was conducted and the following were observed:
  • The living room, dining room and kitchen and laundry room were observed furnished and equipped with the appropriate furniture and equipment for its designated use.
  • All 4 bedrooms contained the required furniture and lighting
  • Required bed linens were observed
  • All 2 bathrooms contained grab bars and a non-skid mat
  • The water temperature was slightly above 120 degrees Fahrenheit and the Administrator was advised to adjust the thermostat to be within range of 105-120 degrees.
  • The interconnected smoke detectors were tested and were operational. The combination smoke/carbon monoxide detectors were also operational.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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 2
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: HARMONY WELLNESS & CARE
FACILITY NUMBER: 195850340
VISIT DATE: 06/25/2024
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
  • Food supply was not reviewed due to having no clients. The Administrator was advised to purchase the required Title 22 food supply prior to accepting the first resident. It is unknown when the facility will complete the vendorization process. Foods purchased for the Pre-licensing visit expired and had to be discarded.
  • The only fire extinguisher is located in the kitchen and was purchased on 6/23/24.
  • the inside of home was observed to be clean.
  • the backyard has a covered patio, currently with a table, sofa and a chair. A new patio set was purchased and stored in the garage for when the facility accepts the first client.
  • Trash cans stored along the right side of the home were observed tightly sealed.
  • The backyard and front yard were observed to be clean.


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: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2