197607711-1-9-2024-31-AS-MCAA-CZBQU2-20240109112801

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607711
Report Date: 01/09/2024
Date Signed: 01/09/2024 11:28:09 AM

Document Has Been Signed on 01/09/2024 11:28 AM - 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:	OUR SWEET HOME INC		FACILITY NUMBER:	197607711
ADMINISTRATOR:	ARUTYUNYAN, TINA		FACILITY TYPE:	740
ADDRESS:	16518 DEVONSHIRE ST		TELEPHONE:	(818) 970-9586
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 6	DATE:	01/09/2024
TYPE OF VISIT:	Case Management - Legal/Non-compliance	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Norma Alfeche		TIME COMPLETED:	11:30 AM

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) Michael Cava conducted Case Management (CM) visit and inspection of the facility to insure facility compliance. On May 27, 2022, a Non Compliance Conference (NCC) was held at the Woodland Hills Regional office. As a result of that NCC, the facility was placed on a three year compliance plan. LPA met with staff, Norma Alfeche and explained the reason for the visit. LPA spoke with the administrator, Tina Arutyunyan, and advised her of the NCC visit. At approximately 9:15am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are battery operated. The carbon monoxide detector, is installed in the dining room, functions properly. The fire extinguisher is located in the kitchen. It was purchased on September 12, 2023. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives and cleaning supplies were stored in a locked drawer. Properly labeled medications were locked in one of the kitchen cabinets. Bedrooms: There were six (6) bedrooms designated for residents' use. Room #5 is a shared room. Rooms 1 to 4 are private. LPAs observed rooms that are occupied by the residents to be properly furnished with appropriate beddings and linens and sufficient lighting. There is one room, designated for staff. Bathrooms: There are three (3) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured between 105 and 110 degrees Fahrenheit. Common Areas: These included both living rooms and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: OUR SWEET HOME INC	FACILITY NUMBER: 197607711
	VISIT DATE: 01/09/2024

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The living room area at the front entrance has a table with four chairs, a television, sign in desk, and fireplace. The fireplace was observed with a screen and glass covering. There were no tools present. According to staff, the fireplace is never in use. LPA did not observe any keys or turn on switch to operate the fireplace, accessible to residents at the time of the visit. The second living room is located towards the back of the facility. It is observed with a couch and television. The alarm at the exit door from the back living room was tested and operational. The dining room has a dining table capable of seating up to six (6) individuals.

Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor
use. The outdoor area was free of hazards. The laundry area is located by the second living room towards the back of the home. Detergents and cleaning supplies were kept locked.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure compliance with licensing forms.

Medications: Medications, medication records, staff and resident records are maintained locked in a kitchen cabinet. Medications and medication records were reviewed for storage and proper documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the day's visit. Exit Interview Conducted and a Copy of the Report Issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC809 (FAS) - (06/04)

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