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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608319
Report Date: 11/07/2022
Date Signed: 11/07/2022 10:49:14 AM

Document Has Been Signed on 11/07/2022 10:49 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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:CHRISTINE'S RETREATFACILITY NUMBER:
197608319
ADMINISTRATOR:CHRISTINE MKRTCHIANFACILITY TYPE:
735
ADDRESS:17145 WILLARD STTELEPHONE:
(818) 578-8468
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 6CENSUS: 6DATE:
11/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Gevorge Mkrtchian - Administrator TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Brian Balisi arrived to this facility today to conduct a One (1) year Required inspection of this facility with emphasis on infection control practices and procedures. Upon arrival, LPA met with Erlinda Patos - Direct Support Professional, who contacted Gevorg Mkrtchian - Licensee Representative. Mr. Mkrtchian arrived shortly after and LPA explained the purpose of the visit.

This home is licensed to serve six (6) ambulatory clients at Level III which North Los Angeles County Regional Center is the vendor. Potentially dangerous items are kept inaccessible to clients with developmental disabilities and intellectual disabilities. There is staff to meet the needs of clients with developmental disabilities and intellectual disabilities. 

At Approx. 08:50am, LPA toured the facility with Administrator. LPA observed (3) clients watching television in the living room, (1) client doing a virtual activity and (2) other clients were at their Day Programs. The kitchen appeared to be relatively  clean at this time and the appliances and fixtures functional during the time of visit.  LPA observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects were observed stored in the top drawer in the area right outside of the kitchen. LPA observed drawer to be locked at this time. Medication cabinet was located in this area as well. LPA observed cabinet to be locked and inaccessible to clients in care. Laundry area was located next to the kitchen. Cleaning products were observed to be inaccessible at this time.

The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident.  The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed four (4) bedrooms that includes a staff room. Staff room was observed to be inaccessible to clients in care and  empty at the of the visit.  All rooms are double occupancy.  Extra linen are kept in a cabinet in the hallway. LPA observed a sufficient supply of linen and  personal hygiene  supplies in the hallway closet nearest to bedroom #1.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CHRISTINE'S RETREAT
FACILITY NUMBER: 197608319
VISIT DATE: 11/07/2022
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Continued from 809

There are three (3) common bathrooms at the home. LPA observed all bathrooms were clean, properly supplied and had functional fixtures. The hot water was measured in each bathroom  between 105 - 120 degrees Fahrenheit.

Common Areas:  These included the living room and dining room.   The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Dining room furniture appeared to be relatively clean and functional at this time.  Client files were observed locked in cabinets in the area outside of the kitchen. LPA observed  first aid kits properly supplied in this cabinet as well.  Fire extinguisher were observed to be fully charged and last serviced in April of 2022.  LPA observed  a 30 day supply of PPE stored easily in multiple locations with the majority of the supplies stored in the garage. 

Outdoor Area:  There was a shaded area with sufficient room for activities. LPA observed sufficient furniture designated for outdoor use. There are no bodies of water on the premises.  LPA observed a sufficient amount of space for activities. LPA did not observe any obstructions to emergency exits at this time.

The LPA spoke with Gevorge regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate any bedroom as a single isolation room as well as the ability to contact Regional Center for temporary placement for any confirmed case of COVID-19. COVID-19 testing is conducted weekly if there are any covid-19 concerns.  The facility’s policies and procedures as it pertains to infection control are adequate at this time.

Exit interview conducted. Report issued and sent via email.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022
LIC809 (FAS) - (06/04)
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