195850503-8-9-2024-29-AS-VCOY-D7YUM4-20240809154144

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850503
Report Date: 08/09/2024
Date Signed: 08/09/2024 03:42:03 PM

Document Has Been Signed on 08/09/2024 03:42 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:	BILLION AGE INC		FACILITY NUMBER:	195850503
ADMINISTRATOR/ DIRECTOR:	HAKOBYAN, ANNA		FACILITY TYPE:	735
ADDRESS:	6530 GLORIA AVE		TELEPHONE:	(361) 222-2223
CITY:	LAKE BALBOA	STATE: CA	ZIP CODE:	91406
CAPACITY: 4		CENSUS: 0	DATE:	08/09/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Anna Hakobyan		TIME VISIT/ INSPECTION COMPLETED:	03:00 PM

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Licensing Program Analyst (LPA) Valeria Conway conducted an announced Pre-Licensing Inspection to the above listed facility. Upon arrival LPA met with Director Anna Hakobyan. Entrance interview conducted.

An application to operate an Adult Residential Facility (ARF) was received by Community Care Licensing (CCL) on 02/02/2024. A Fire Clearance was approved for a maximum capacity of four (4), two (2) ambulatory and two (2) non-ambulatory clients on 05/01/2024. The proposed physical plant is a one (1) story single family dwelling located in a residential neighborhood of Lake Balboa, CA. This facility will be housing clients from Regional Center, and it will be classified as a Level 3 housing. Regional Center application is in process and not approved at the time of the visit. This facility does have a staff room (Room #3). At the time of the visit, the Director and their family are residing at this location temporarily until clients from the Regional Center are admitted. There are no client residing in the facility at the moment.

At 9:45 am a tour of the physical plant was conducted and the following observed:

BEDROOMS: There are four (4) bedrooms, which Room #3 will be for staff use only. Two bedrooms (Room #1 and Room #2) are for single occupancy and Room #4 is for double occupancy. All bedrooms were equipped and supplied with appropriate furniture, bedding, and linens. No client bedroom will be used as a public or general passageway to another room, bath, or toilet. There were no visible hazards or discrepancies observed. Facility does not have auditorial signal at the time of the visit.

Continues LIC 809C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

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: BILLION AGE INC	FACILITY NUMBER: 195850503
	VISIT DATE: 08/09/2024

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Continued from LIC 809C

BATHROOMS: There are two (2) bathrooms, LPA observed toilet paper and soap ready to use, paper towels and other hygiene products will be provided before facility admits clients. Additionally, bathrooms had nonslip rugs, and grab bars. Water temperatures were measured in all client bathrooms and measured within the required range of 105 degrees Fahrenheit to 120 degrees Fahrenheit at the time of the visit.

KITCHEN: Appliances and fixtures appeared clean and functional. At the time of the visit, LPA observed non-perishable food in the garage and perishable food at the time of the visit to accommodate a maximum capacity of four (4) clients and facility staff for seven (7) days. There was sufficient dining and cookware to accommodate a maximum capacity of four (4) clients and staff. Knives and other sharps will be stored in a locked kitchen drawer. There were no visible immediate hazards observed. At 10:10 A.M. hot water measured 119.1 degrees Fahrenheit. LPA observed, between the kitchen and bathroom #1, in the hallway a locked closet which will store client’s files and medication. 1^st aid kit was observed inside this closet, manual was not included. Director will buy a manual and submit proof to LPA once it is received.

COMMON AREAS: These include the Family Room and Dining Room. Additionally, a locked laundry room/closet was observed next to bathroom #2. LPA observed cleaning supplies and disinfectant locked in a closet next to the laundry closet. The staff will assist clients with all laundry needs. Cleaning supplies and detergents were locked and inaccessible to clients. Night lights were observed in hallways passages to nonprivate bathrooms and in the bedrooms. The common areas were furnished to accommodate a maximum capacity of four (4) clients. A fire extinguisher was observed throughout the facility; it was fully charged and last purchased on 04/21/2024. At 10:33 A.M., hardwired combination carbon monoxide/smoke detectors were tested and were functional at the time of the visit. Phone and internet system will be connected before the first client is admitted. Facility is clean, safe, sanitary and in good repair at the time of the visit. LPA did not observe sufficient amount of emergency water. Director will buy emergency water and submit proof of purchase to LPA. LPA observed required posting throughout the facility.

Continues on LIC 809C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

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: BILLION AGE INC	FACILITY NUMBER: 195850503
	VISIT DATE: 08/09/2024

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Continued from LIC 809C

SURROUNDING GROUNDS: LPA observed exterior cameras surrounding the facility. The Front yard includes a driveway and paved walkways. There is an in-ground swimming pool. The pool is kept inaccessible to clients with the use of fencing that includes a locked gate. There is one (1) side gate doors with self-latching mechanisms. The facility is providing a shaded, comfortable, and furnished outdoor activity area for clients. All outdoor and indoor passageways were observed free of obstruction.

COMPONENT III ORIENTATION: A Component III Orientation was conducted with Director Anna Hakobyan during today's visit.

The following needs to be completed/Photos sent to LPAs prior to licensure:

 Emergency water supplies.
 First aid kit manual

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 conducted. A copy of the Licensing Report was issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

LIC809 (FAS) - (06/04)

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