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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850430
Report Date: 04/04/2024
Date Signed: 04/04/2024 10:52:44 AM


Document Has Been Signed on 04/04/2024 10:52 AM - 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:ANGELS HANDS SENIOR LIVINGFACILITY NUMBER:
195850430
ADMINISTRATOR:GHUKASYAN, MARINEFACILITY TYPE:
740
ADDRESS:14819 VALERIO STREETTELEPHONE:
(818) 679-4442
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY:6CENSUS: 0DATE:
04/04/2024
TYPE OF VISIT:POCANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Marine Ghukasyan, ApplicantTIME COMPLETED:
10:55 AM
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Licensing Program Analyst(LPA), Christine Yee, conducted a subsequent announced case management visit to verify that the deficiencies observed during the initial Prelicensing and Component III visit conducted on 3/21/24 was corrected. LPA Yee met with Marine Ghukasyan, Applicant. Also present during the visit was Gevorg George Gevshenyan, family member.

Per today's visit, the following corrections were observed:
  • the water temperature was tested in the common bathroom and it read 119.6 degrees Fahrenheit
  • the water temperature was tested in the private bathroom and it read 119.5 degrees Fahrenheit.
  • a blanket and a flat sheet was observed on each resident bed and 2 extra blankets were observed stored in the residents closet in each room
  • a grab bar was observed in the shower stall located in the private bathroom
  • the Long Term Care Ombudsman poster was obtained and was observed posted by the front door
  • the complaint poster that met Title 22 size requirements of 20" X 26" was observed posted on the living room wall by the front door.*
  • the water stain on the living room ceiling was painted.
  • the double sided fire place between the living room and family room was observed with a fire screen on each side.
  • the sliding screen door of the family room was observed to be repaired.
  • a window screen was observed on the window located in bedroom #1.

The following must be completed once the facility is licensed:
  • liability insurance that meets Title 22 requirements will be purchased.
  • perishable foods for a minimum of 2 days will be purchased prior to the acceptance of the first resident.

Exit interview was conducted.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2024
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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