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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850487
Report Date: 09/04/2024
Date Signed: 09/04/2024 01:35:03 PM

Document Has Been Signed on 09/04/2024 01:35 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 LIVINGFACILITY NUMBER:
195850487
ADMINISTRATOR/
DIRECTOR:		SARGSIAN, HARUTFACILITY TYPE:
735
ADDRESS:7809 GENESTA AVE.TELEPHONE:
(818) 519-8080
CITY:LAKE BALBOASTATE: CAZIP CODE:
91406
CAPACITY: 4CENSUS: 0DATE:
09/04/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:06 AM
MET WITH:Harut SargsianTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Sandra Urena conducted a Pre-licensing visit at 10:10 a.m. and met with the Administrator and applicant Harut Sargsian. This is a new facility application for an Adult Residential Facility (ARF) four (4) non-ambulatory residents, which one can be a bedridden resident. Fire Clearance was approved on 12/14/2023 for one bedridden resident in bedroom #2.

At 10:20 a.m., the LPA, and the applicant toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: Kitchen knives are stored locked and inaccessible in the pantry cabinet. A seven-day supply of non-perishable food was available. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen cleaning supplies will be stored and locked under the kitchen sink. Hot water temperature was recorded at 115.0 degrees Fahrenheit. Trash cans have a tight-fitting lid. There were no pesticides or toxins stored near food, or preparation area. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. A fire extinguisher is located near the backdoor exit, which was purchased on 01/24/2024.

BEDROOMS: There are (4) bedrooms for residents in care. Room 1 will be a shared room; applicant will email a new sketch to the Community Care Licensing office to reflect the changes to the rooms’ designations. Bedrooms #2 and #3 are designated as private rooms. Room #2 was approved by the fire department as the bedridden bedroom. All other bedrooms are cleared for non-ambulatory. All bedrooms were supplied with all required bedding and linens. There is sufficient lighting as well as closet and drawer space available.


Continues on LIC 809C...
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2024
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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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 LIVING
FACILITY NUMBER: 195850487
VISIT DATE: 09/04/2024
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BATHROOMS: There are (2) full bathrooms. Bathrooms are equipped with toilet and shower grab bars. There are sufficient supplies of towels, paper goods and personal hygiene supplies. Hot water delivered at 115 degrees Fahrenheit.

COMMON AREAS: These include a living space equipped with a television. There is a dedicated area for the posting of required documents. Smoke and carbon monoxide alarms were tested and functional at the time of the visit. Medication, resident and staff files are stored and locked in laundry room area.



LAUNDRY ROOM: There is a laundry area equipped with washer and dryer. Detergents and cleaning supplies will be stored in locked cabinet above the washer and dryer.

SURROUNDING GROUNDS: The exterior passageways were clean and clear of any obstructions. The patio is furnished with outdoor furniture for residents’ use, and shade is available. The building has a central entrance for residents and visitors. Fire emergency gates are clear of obstructions.

At 11:40 a.m., the applicant completed Component III orientation.

This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.

Exit interview was conducted and reviewed with applicant the applicant. A copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC809 (FAS) - (06/04)
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