197608349-8-12-2022-31-AS-NRED-CH8UP6-20220812154501

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608349
Report Date: 08/12/2022
Date Signed: 08/12/2022 03:45:07 PM

Document Has Been Signed on 08/12/2022 03:45 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	ABBEY ROAD VILLA		FACILITY NUMBER:	197608349
ADMINISTRATOR:	MARINE KARAPETIAN		FACILITY TYPE:	740
ADDRESS:	14132 HUBBARD STREET		TELEPHONE:	(818) 837-0077
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY:	78	CENSUS: 51	DATE:	08/12/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Marine Karapetian		TIME COMPLETED:	03:55 PM

NARRATIVE

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At 2:10 p.m. on 08/12/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. On 08/11/2022 the Long Term Care Ombudsman (LTCO) visited the facility. The Administrator reported the Air Conditioning was broken. The internal temperature was recorded at approximately 82 degrees Fahrenheit. Due to these concerns, a case management visit was initiated. LPA met with Administrators Marine Karapetian and Virginia Sumulong and disclosed the reason for the visit. LPA and Administrator Virginia toured the facility inside and out. During the physical plant inspection, no immediate health and safety concerns were observed.

LPA interviewed Administrators at 2:35 p.m. and 3:00 p.m. LPA interviewed Resident #1 (R1), Resident #2 (R2), and Resident #3 (R3) from 2:45 p.m. to 3:10 p.m. LPA recorded temperatures on the facility’s exterior and interior from 2:10 p.m. to 2:55 p.m.

From interviews, Administrators stated that the air conditioner for R1, R2, and R3 went into disrepair in the afternoon on 08/10/2022. The facility called for service that day, and due to delayed parts, the air conditioners were fixed on the morning of the 08/12/2022. In the meantime, the facility offered to relocate the residents. R1, R2, and R3 reported that the temperatures of their current rooms are to their liking. From temperature recordings, the facility maintains the building temperature within regulations.

During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

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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