195850529-10-22-2024-29-AS-TBYE-DAAQKR-20241022121446

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850529
Report Date: 10/22/2024
Date Signed: 10/22/2024 12:14:57 PM

Document Has Been Signed on 10/22/2024 12:14 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:	HELPING HANDS SENIOR LIVING, INC.		FACILITY NUMBER:	195850529
ADMINISTRATOR/ DIRECTOR:	PALEZYAN, ANI		FACILITY TYPE:	740
ADDRESS:	8022 IRVINE AVE.		TELEPHONE:	(818) 394-9029
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY: 6		CENSUS: 5	DATE:	10/22/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:22 AM
MET WITH:	Ani Palezyan		TIME VISIT/ INSPECTION COMPLETED:	12:30 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) Trevor Byrne conducted a pre-licensing visit to the above noted facility at 09:22 AM. The LPA met with applicant, Ani Palezyan. This is a change of ownership application. A dementia program was included in the plan of operation. A Hospice Waiver has been requested. The facility is one story. At 09:23 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for five (5) non-ambulatory residents; and one (1) bedridden resident. The facility has three (3) shared rooms, Room #’s 1, 2, and 3. Rooms # 2 and 3 have direct exits to the outside and bedroom #3 is the bedridden approved room. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. There are no staff rooms awake night staff only is required. All rooms were free of odors. All window screens were clean and maintained in good repair. There is one (1) shared resident bathroom in the hallway and one (1) private resident bathroom attached to room #1. The resident bathrooms have a shower with non-skid materials. The toilet and shower have grab bars and all were properly secured. The hot water temperature was tested in the bathrooms. The hot water temperature was measured as follows: bathroom #1= 111 F and bathroom #2 = 113.9, which falls within the allowable range of 105 F to 120 F. Continued on 809C.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

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: HELPING HANDS SENIOR LIVING, INC.	FACILITY NUMBER: 195850529
	VISIT DATE: 10/22/2024

NARRATIVE

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Resident and staff records are stored in a cabinet which is currently located in the living room. Medications are centrally stored in a locked cabinet in the living room. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored on a shelf in the entryway to the facility.

Kitchen knives are stored in a locked cabinet located under the sink in the kitchen. Stove burners are rendered inaccessible to the residents by removing them when not in use. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0 F) and the refrigerator was maintained at forty degrees Fahrenheit (40 F). There is a sufficient supply of two (2) days perishable and seven (7) days non-perishable foods. There are no pesticides, poisons, or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked closet located in the dining area. No flies or other vermin were observed.

The common areas were appropriately furnished, and the lighting was adequate. There are televisions and other entertainment equipment, games, and activity supplies in the living room and dining area. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. No ramps were observed at the facility. There was no fireplace observed at the facility. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit.

The facility smoke alarm system is hard wired. The smoke detector and carbon monoxide detectors were tested at 10:54 AM and functioned properly during the time of visit. There is one (1) fire extinguisher throughout the house. It is fully charged and does not exceed the expiration date.

Continued on LIC 809C.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

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: HELPING HANDS SENIOR LIVING, INC.	FACILITY NUMBER: 195850529
	VISIT DATE: 10/22/2024

NARRATIVE

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Hot water was tested in each bathroom, which included the private resident bathroom and the common bathroom, in addition to the kitchen; and the hot water ranged from 111 to 113.9 degrees Fahrenheit. The laundry area is located in the hallway. The supply of extra bed and bath linens is adequate. Personal hygiene items were adequate and are stored in a locked closet in the dining area. Extra incontinence supplies are stored in the locked closet in the dining area. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted near the doors to all resident rooms. The emergency telephone numbers as well as other required postings are posted in in the dining area.

The exterior passageways were clean and clear of any obstructions. There is a covered area at the front of the house with tables and chairs where residents can sit. The entire property is fenced. The facility is separated from a house located at the front of the property that has a separate address and is not associated with the facility. There is no driveway gate located at this property. There is a door gate with a self-latching mechanism for persons to enter the front yard. There are no additional storage sheds located at the facility. There are not any bodies of water on the premises at the present time. There is no garage located at the facility. At 09:33 AM LPA Byrne observed a bottle of pesticides located unsecured and accessible to clients in care located on the floor of the backyard. Facility administrator Ani secured the bottle immediately.

During today’s visit COMP III orientation was completed with facility administrator Ani Palezyan. The following items must be corrected prior to licensure. Submit proof of corrections, a statement of understanding, and a copy of this report, to LPA Trevor Byrne so that your application may be completed.

87705
Care of Persons with Dementia
(f) The following shall be stored inaccessible to residents with dementia:
(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.

This report will be sent to the Centralized Application Bureau (CAB) once all corrections are received. 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.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

LIC809 (FAS) - (06/04)

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