197608579-8-17-2023-31-AS-RVAA-CUSURP-20230817154905

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608579
Report Date: 08/17/2023
Date Signed: 08/17/2023 03:53:21 PM

Document Has Been Signed on 08/17/2023 03:53 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	NO PLACE LIKE HOME FOR GOLDEN AGES		FACILITY NUMBER:	197608579
ADMINISTRATOR:	EMMA TOPADZHIKYAN		FACILITY TYPE:	740
ADDRESS:	1459 WESTERN AVENUE		TELEPHONE:	(818) 245-6799
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91201
CAPACITY:	6	CENSUS: 6	DATE:	08/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	, Gayane Khachatryan, Staff		TIME COMPLETED:	04:00 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	A Required One (1) year - Annual visit was conducted today by Licensing Program Analyst (LPA) Rosaura Valenzuela. LPA met with staff Gayane Khachatryan and explained the purpose of the visit. LPA observed that six (6) residents were at the facility during visit. A tour of the physical plant was conducted at 12:30 PM and the following was noted: The front main door is the only entrance being utilized at the facility. The facility is a single story home with four (6) private client bedrooms and three (3) bathrooms. There is no body water in the facility. Bedrooms were toured and observed to be clean and properly furnished. Linen storage was also checked and observed to have ample supply of clean linen and towels. Bathrooms were observed to be clean and sanitary with necessary supplies. Hot water temperature measured at a range of 105.6°F to 114.3°F and within the required range. Physical plant was checked for cleanliness and condition. Facility was in good repair and observed to be clean and free of clutter during today's visit. Living, dining & family room furniture were also checked for functionality (wear and tear). Furniture was observed to be in good condition. Kitchen area was observed to be clean and sanitary. All the toxins, cleaning solutions and disinfectants are locked in the cabinet below the kitchen sink. Knives and sharps are kept in the a locked storage located near the dining area. Food. The facility is observed to have sufficient food supply for the clients both perishable and non-perishable. Temperature of facility wall thermostat is set at 74.0°F and observed to be within the required range. Fire extinguishers. The facility has three (3) fire extinguishers which were last bought on 01/25/22. Carbon monoxide and smoke alarms are hardwired and interconnected, tested and observed to be operable.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: NO PLACE LIKE HOME FOR GOLDEN AGES	FACILITY NUMBER: 197608579
	VISIT DATE: 08/17/2023

NARRATIVE

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Garage is attached to the house and access has to go through the Laundry room. Garage was observed to be locked and inaccessible to residents. The garage is also used as a storage for PPE and other supplies.

Client records were reviewed for current IPP’s and/or Needs and Service plans, physician report, admission agreements, etc. Client records appeared to be complete and current.

Medication was observed to be inaccessible to residents and stored in a secured cabinet. There is a complete First Aid kit.

Staff records were reviewed. Staff present records were observed to be current and updated.

Exit interview conducted and a copy of this report was given.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC809 (FAS) - (06/04)

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