<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608325
Report Date: 10/06/2023
Date Signed: 01/09/2024 03:02:01 PM


Document Has Been Signed on 01/09/2024 03:02 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:ZANN DAILY CAREFACILITY NUMBER:
197608325
ADMINISTRATOR:ANN SOLAKYANFACILITY TYPE:
740
ADDRESS:11500 BAIRD AVENUETELEPHONE:
(818) 635-9471
CITY:NORTHRIDGESTATE: CAZIP CODE:
91326
CAPACITY:6CENSUS: 5DATE:
10/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Ann Solakyan- AdiministratorTIME COMPLETED:
02:00 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
On 10/06/23 Licensing Program Analysts (LPAs) Mariana Agban,Huma Rahimi and Leslie Ngo-Castandena, conducted an Annual Required visit and inspection of the facility. Upon arrival, LPAs was greeted by the staff and explained the reason for the visit. A tour of the physical plant was conducted at 9:30 AM.
Kitchen: The kitchen appeared clean and the appliances and fixtures functional. LPAs found a sufficient amount of perishable and non-perishable food at the facility; properly stored. LPAs observed that sharp objects were stored in unlocked drawer. Staff immediately locked the drawer. Medications are locked in the hallway cabinet. Medications observed to be locked and inaccessible to clients. LPAs observed fully stocked first aid kit in the hallway cabinet.
Bathrooms: There were two (2) bathrooms in the facility. One (1) bathroom in hallway which is the main and one (1) bathrooms in the private bedroom. All bathrooms were clean, properly supplied and had functional fixtures. Water temperatures were: 118.5 and 119.3 degrees Fahrenheit. Bedrooms: There were six (6) bedrooms designated for residents' use. All bedrooms were clean, properly furnished and had sufficient lighting. Common Areas: These included the living room and dining area. The common areas were properly furnished Surrounding Grounds: Entry/exits were free of obstruction.Temperature: Facility maintains a comfortable temperature of 78 degrees Fahrenheit. Fire extinguisher: are located in the dining room, and kitchen observed to be fully charged and was purchased on 07/23/2023 and 06/29/23. Laundry Area-Garage: located in the garage. Appliances observed to be in good repair. Garage door was locked and thus laundry detergents were inaccessible to residents. Backyard Area: a patio table and chairs shaded by a large umbrella for residents use. Patio furniture observed to be in good repair with adequate seating for the residents. There is a pool enclosed by a gate. Gate to the pool observed to be locked and inaccessible to clients. Due to discrepancy of the facility records, this annual will be continued in a another time.

Exit interview conducted and deficiencies cited and copy of this report delivered.

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana AgbanTELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2023
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 3


Document Has Been Signed on 01/09/2024 03:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364


FACILITY NAME: ZANN DAILY CARE
FACILITY NUMBER: 197608325

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87705(f)(1)


This requirement is not met as evidenced by: 87705(f)(1) Care of persons with Dementia The following shall be stored inaccessible to residents with dementia:(1)Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s).
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above. LPA observed sharp objects drawer unlocked. This poses/posed an immedate health, safety or personal rights risk to persons in care.
POC Due Date: 10/13/2023
Plan of Correction
1
2
3
4
The caregiver immediately locked the knife in the draw with the other sharp objects. The Administrator stated they will train staff on how to properly lock sharp objects after use. Proof of training will be submitted to the LPA.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana AgbanTELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 01/09/2024 03:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364


FACILITY NAME: ZANN DAILY CARE
FACILITY NUMBER: 197608325

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87705(f)(1)
Care of Persons with Dementia
(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
Plan of Correction
1
2
3
4
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana AgbanTELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3