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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603506
Report Date: 12/28/2024
Date Signed: 12/28/2024 03:25:43 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/28/2024 03:25 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:LARC ELDERLY HOME IIFACILITY NUMBER:
197603506
ADMINISTRATOR/
DIRECTOR:		BRATZEL, CHRISTINEFACILITY TYPE:
740
ADDRESS:29894 BOUQUET CANYON ROADTELEPHONE:
(661) 296-8636
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:34 PM
MET WITH:Trina LeskoTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Abeye Duguma met with Trina Lesko for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 01:30 PM and the following was noted:

There are multiple entrance being utilized at the facility. The facility has a total of five (05) bedrooms, of which one (01) is for staff and three (03) bathrooms for both residents and staff. The facility is fire cleared for four (04) non-ambulatory and has a total capacity of eight (08). The facility is currently occupying zero (00) residents.

The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility's swimming pool is fenced and locked. Laundry detergents, cleaning agents and other toxins are locked away.

Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents.

The living and dining rooms are neat and clean. The facility maintains a comfortable temperature at 73°F. The smoke and carbon monoxide detectors are hardwired, interconnected and checked periodically. Fire extinguishers are located throughout the facility, observed to be full and last inspected 02/15/2024.
(continued on LIC 809-C)
Naira MargaryanTELEPHONE: (818) 596-4368
Abeye DugumaTELEPHONE: (818) 669-6814
DATE: 12/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2024
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LARC ELDERLY HOME II
FACILITY NUMBER: 197603506
VISIT DATE: 12/28/2024
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The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 111.6°F.

LPA observed medication and first aid kit to be locked and inaccessible to residents.

No health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye DugumaTELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2024
LIC809 (FAS) - (06/04)
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