197608312-5-20-2021-31-AS-NMAN-C37UXW-20210520155902

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608312
Report Date: 05/20/2021
Date Signed: 05/20/2021 04:03:49 PM

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:	ADL BEST CARE LLC		FACILITY NUMBER:	197608312
ADMINISTRATOR:	ANNA VARDANYAN		FACILITY TYPE:	740
ADDRESS:	5433 MONROE STREET		TELEPHONE:	(323) 461-5602
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90038
CAPACITY:	5	CENSUS: 4	DATE:	05/20/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Anna Vardanyan		TIME COMPLETED:	04:15 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) Naira Margaryan conducted unannounced Required 1-year visit to the facility. LPA met the Administrator Anna Vardanyan, explained the purpose of this visit and was greeted by the administrator herself. LPA observed one (01) residents was in the living room watching TV. Three (03) residents were comfortably resting in their respective bedrooms. . A tour of the physical plant was conducted with Ms. Vardanyan. The facility has three (3) bedrooms and two (2) bathrooms currently occupying four (4) residents. The facility is licensed to care for five (5) non-ambulatory residents and has hospice waiver for two (2). Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked and meets requirements. Living and dining room furniture were also checked. The living room is neat and clean along with the dining room. The facility maintains a comfortable temperature. The smoke/carbon monoxide detectors are hardwired and interconnected and observed to be operational. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water at the facility. The Administrator's office is located in the backyard and was observed to be locked and inaccessible to residents. There is also a separate storage which was also observed to be locked. The laundry area is located in the backyard locked and inaccessible to residents.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Naira Margaryan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2021

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: ADL BEST CARE LLC	FACILITY NUMBER: 197608312
	VISIT DATE: 05/20/2021

NARRATIVE

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The garage is detached to the home and inaccessible to residents. The garage is currently being used as an emergency food and supplies storage, Laundry detergent and other toxins are also kept in there.

Food Service/Kitchen area was sufficiently stocked with two (2) days perishable food and seven (7) days of non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean. Fire extinguisher is located in the kitchen and observed to be fully charged but not inspected since May 2019. The Administrator contacted her spouse, who went to buy a new fire extinguisher.
Knives and sharps were observed to be locked in a kitchen cabinet.

The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are clear from obstruction. Clients have sufficient amounts of personal hygiene product which is provided by the licensee.

The bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was measured at 119.6°F. Towels and washcloths are not shared. There was enough clean linen available in stock at the cabinet.

Medications: LPA observed that the medication was kept in the kitchen cabinet locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. There was a complete first aid kit located in the medication cabinet.

Required posting including Covid 19 emergency postings as well as other documents are observed to be complete and displayed properly at the facility.

The copies of facility mitigation and emergency disaster plan was requested and reviewed with the Administrator.

No health and safety hazard is noted during this visit.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Naira Margaryan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2021

LIC809 (FAS) - (06/04)

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