197606792-7-16-2024-31-AS-GSAO-D78R35-20240716123921

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606792
Report Date: 07/16/2024
Date Signed: 07/16/2024 12:39:49 PM

Document Has Been Signed on 07/16/2024 12:39 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	LUXOR LIVING		FACILITY NUMBER:	197606792
ADMINISTRATOR:	SAMEA HELMANDI		FACILITY TYPE:	740
ADDRESS:	17835 PARTHENIA STREET		TELEPHONE:	(818) 687-6877
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	6	CENSUS: 5	DATE:	07/16/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Roshawn Helmandi		TIME COMPLETED:	12:50 PM

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On 07/16/2024 at 9:05 AM, Licensing Program Analyst (LPA) Gina Saucedo conducted an unannounced, Annual Inspection and met with Roshawn Helmandi. LPA asked for the census, staff and resident files.

The physical plant was toured inside and out at 10:25 am.

Living/Dining Room Area: LPA Saucedo observed the living room furniture to be clean and in good repair. The facility maintains a comfortable temperature at 79 degrees Fahrenheit with a large television. There is a fireplace that is covered. The telephone line is in the dining hall. There is one (1) fire extinguisher fully charged and expires on July-2025.

Bedrooms: There are six (6) bedrooms. Five (5) are used for residents and one (1) for a staff. Four (4) rooms are single, occupied and one (1) is shared. In the hallway, there is a pantry filled with PPE’s and the first aid kit. LPA observed rooms to have bedding sheets, pillowcase, blankets, nightstands, televisions, and sufficient lighting for each of the resident’s room. There is also a signal system in each of the resident rooms.

Bathrooms: There are three (3) bathrooms that were toured and checked to make sure bathrooms were clean and in good repair. The hot water temperatures were measured within regulations of 105 degrees. The showers have non-slip bathmats and grab bars.

Medications were kept in a locked cabinet in the kitchen on your right-hand side. All medications were properly labeled and inaccessible to residents.

Kitchen Area: LPA inspected the kitchen area. There is one (1) refrigerator which was clean and in good operation. LPA observed sufficient supply of seven (7) day non-perishable and perishable foods in the cabinets. The knives/sharps are in the kitchen on your right-hand side, inaccessible to the residents.

LIC 809C-continued

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024

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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LUXOR LIVING	FACILITY NUMBER: 197606792
	VISIT DATE: 07/16/2024

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Outside: LPA toured the outside area. LPA observed a covered shaded area for residents and appropriate outdoor furniture. The facility has no body of water on the premises. There is one gate that is unlocked leading to the outside area towards the street. There is a basketball court in this area.

The washer and dryer are located outside in a locked room inaccessible to the residents. There is also another side room that is used for an office. LPA was able to observe the room.

The carbon monoxide and the smoke detector were tested, and they were operable, interconnected.

There is no garage but there is a shed locked and inaccessible to the residents. The shed was open, and the LPA was able to observe there was extra furniture in there.

There is a signal system for the facility. There is a subdivision house on the property in where the residents do not have access. It is not part of the above facility. This is the actual entrance of the facility due to not having access from the street area.

Administration: The Liability Insurance was reviewed and was recently renewed on 06/2024. There are several Covid 19 signs on the wall, hygiene sanitation signs, and the Ombudsman sign against the walls of the facility.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024

LIC809 (FAS) - (06/04)

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