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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608345
Report Date: 04/08/2024
Date Signed: 04/08/2024 05:49:01 PM

Document Has Been Signed on 04/08/2024 05:49 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:VICTORY HOMEFACILITY NUMBER:
197608345
ADMINISTRATOR/
DIRECTOR:		ANDREW AKHPARIANFACILITY TYPE:
735
ADDRESS:6228 BABCOCK AVETELEPHONE:
(818) 585-0095
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 4CENSUS: 4DATE:
04/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:12 AM
MET WITH: Andrew Akhparian, AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:50 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) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and was let into the home by Marika Petevotyan, Staff. Andrew Akhparian, Administrator was contacted by staff and he arrived at 10:34am to conduct the visit and left at 10:39am to get a copy of the Plan of Operations, Emergency Disaster Preparedness Plan and the Infection Control Plan which were not maintained on the premises and returned at 11:11am. The reason for today's visit was explained. Also participating in today's visit was Diana Gevorgyan, Assistant Administrator.

The home is a single storey family home consisting of a living room, dining room, kitchen, family room, 5 bedrooms of which two is designated for live-in staff. 1 of the two bedrooms is also is used as a bedroom/ office. The home has 3 full bathrooms. Located in the backyard is a swimming pool which is surrounded by a 5 feet rod iron fence. The home is vendorized by the North Los Angeles Regional Center as a Level 2 home.

LPA Yee reviewed 4 client files, 3 staff files, toured the facility inside and outside and completed the following domains: Physical Plant and Environmental Safety, Staffing and Clients Right-Information.
The following were observed:
  • the living room, dining room and family room was appropriately furnished for the use by 4 clients
  • the kitchen was equipped with a stove, microwave and a dishwasher. Knives are stored in a locked kitchen drawer, toxins are stored in a locked cabinet under the sink and medications are stored in a locked cupboard in the hallway.
  • the screen door located in the family room was observed to be ripping by the door handle
  • bedroom #1 was observed with a twin bed, night stand, 2 dressers, a closet, a television and a armchair. The windows were observed with blinds.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2024
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VICTORY HOME
FACILITY NUMBER: 197608345
VISIT DATE: 04/08/2024
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
26
27
28
29
30
31
32
  • bedroom #2 was observed with 1 twin bed, a chair, a dresser, a night stand and had no lamp. Sufficient lighting was observed. The bed did not have a flat sheet or comforter
  • bedroom #3 was observed furnished with 2 twin beds equipped with drawers, 2 night stands, a small 3 drawer dresser, 1 chair, a large walk in closet with shelves and drawers. The bed located closest to the closet was observed with just a mattress cover and 2 blankets. Missing from the bed was a fitted sheet, a flat sheet, a pillow case and a comforter. Per review of the linen closet, a couple of flat sheets and pillow cases were observed in the linen closet. Located inside bedroom #3 is a private bathroom with a shower, a toilet and a sink. The water temperature was tested and it read 114.5 degrees Fahrenheit.
  • bedroom #4 is used by staff as a bedroom/office and contains a king size bed and personal clothing. Located inside the room is a private bathroom.
  • the staff bedroom located in the front, by the kitchen was observed with a queen size bed and personal belonging and is locked.
  • the common bathroom located by bedroom #1 is equipped with a bathtub, a shower stall, a toilet and a 2 sink vanity. Water temperature was tested and read 111.7 degrees Fahrenheit.
  • the individual smoke detectors located in bedroom #1 - bedroom #3 and in the hallway were tested and were operational.
  • the 2 carbon monoxide detectors, one located by bedroom #1 and by the laundry room were tested and were operational.
  • the laundry room located by the back staff room was observed with a washer and dryer. Non-perishable foods and extra perishable foods were stored in the extra refrigerator. Sufficient perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days were observed.
  • 2 fire extinguishers were observed in the laundry room and one was observed in the kitchen. Per the Administrator, they were purchased in March 2023 and will be replaced with newly purchased one.
  • first aid kit was reviewed and contained a thermometer, scissors and tweezer and a pocket reference guide.
  • Per tour of the backyard, front yard and along the side of the home, cleaning is needed. All furniture, plastic bucket, mops, brooms, tables, desks, boxes, sun chairs, wooden planks, open house posters, boxes, recycling items need to be discarded or stored away. Trash cans stored in the backyard were full of boxes and trash and could not be tightly sealed.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 04/08/2024 05:49 PM - It Cannot Be Edited


Created By: Christine Yee On 04/08/2024 at 04:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VICTORY HOME
FACILITY NUMBER: 197608345

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above as per tour of the facility, the screen door located in the family room was observed to be ripping by the door handle which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/15/2024
Plan of Correction
1
2
3
4
Licensee will ensure that all facillity screens are checked to ensure that there are no rips in the screen. Licensee will get the screen on the sliding screen door repaired and provide evidence of completed repairs by 4/15/24
Type B
Section Cited
CCR
80088(f)(1)
Fixtures, Furniture, Equipment, and Supplies
(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers, including movable bins, used for storage of solid wastes shall have tight-fitting covers kept on the containers; shall be in good repair, shall be leakproof and rodent-proof.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above as per tour of the outside areas, the trash cans located in the backyard were observed to be filled with trash and cardbox boxes that prevented the trash can lids from being being tightly sealed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/15/2024
Plan of Correction
1
2
3
4
Licensee will ensure that the trash cans are emptied out weekly so that the trash cans lids can be tightly sealed at all times to prevent the breeding of rodents or insects. LIcensee will provide evidence that the trash cans are tightly sealed at all times. by 4/15/24
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:Kristin Heffernan
LICENSING EVALUATOR NAME:Christine Yee
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2024


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 04/08/2024 05:49 PM - It Cannot Be Edited


Created By: Christine Yee On 04/08/2024 at 04:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VICTORY HOME
FACILITY NUMBER: 197608345

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85065.6(b)(1)
Night Supervision
(b) Employees providing night supervision from 10:00 p.m. to 7:00 a.m., as specified in (c) through (f) below, shall be available to assist in the care and supervision of clients in the event of an emergency, and shall have received training in the following: (1) The facility's planned emergency procedures.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview with the Administrator, the licensee did not comply with the section cited above as the live-in staff who was hired on 12/4/23 and is the only staff present in the facility at night, has not received training in the facility's planned emergency procedures, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/15/2024
Plan of Correction
1
2
3
4
Licensee will provide all staff who provide night supervision from 10:00pm to 7:00am training on the facility's planned emergency procedures prior to working alone at night. Provide staff training and provide a copy of the training log that shows the date when the training was conducted, how long the training was, who attended and the name of the instructor by 4/15/24
Type B
Section Cited
CCR
85088(c)(4)(A)
85088 Fixtures, Furniture, Equipment and Supplies
(c) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. (4)Clean linen in good repair, including lightweight, warm blankets and bedspreads; top and bottom bed sheets; pillow cases; mattress pads; rubber or plastic sheeting, when necessary; and bath towels, hand towels and washcloths.(A) The quantity of linen provided shall permit changing the linen at least once each week or more often when necessary to ensure that clean linen is in use by clients at all times.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above per tour of the bedrooms, the bed in Bedroom #2 did not have a flat sheet and a comforter and the bed closest to the closet did not have a fitted sheet, flat sheet, a pillow case as the client took them home for washing. No extra linens were availables to allow staff to make the bed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/15/2024
Plan of Correction
1
2
3
4
Licensee will ensure that there are sufficient linens available to allow the linens to be washed weekly or as often as needed. Licensee will purchase more bed linens in the quantity that will allow for weekly changing or as needed and provide evidence by 4/15/24
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:Kristin Heffernan
LICENSING EVALUATOR NAME:Christine Yee
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2024


LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VICTORY HOME
FACILITY NUMBER: 197608345
VISIT DATE: 04/08/2024
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
26
27
28
29
30
31
32
Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 1 and Chapter 6. Any deficiencies not addressed on today's visit will be addressed on a return visit

Exit interview was conducted, APPEALS RIGHTS discussed and a copy was given.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5