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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608610
Report Date: 02/24/2025
Date Signed: 02/24/2025 04:38:45 PM

Document Has Been Signed on 02/24/2025 04:38 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:AMBITIONS - VERDUGO HOUSE 2FACILITY NUMBER:
197608610
ADMINISTRATOR/
DIRECTOR:		LUCY KECHEDJIANFACILITY TYPE:
735
ADDRESS:3206 W VERDUGO BLVDTELEPHONE:
(818) 562-7794
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 4CENSUS: 4DATE:
02/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Blanca Alvarez Esparza - AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced Required - 1 Year annual inspection visit. At 8:40 am LPA met with Blanca Alvarez Esparza/Administrator and explained the purpose of the visit. The Adult Residential Facility is licensed for four (4) ambulatory adults. Current census is four (4) ambulatory clients. The program is vendorized through the Frank D. Lanterman Regional Center. The facility is a home located in a residential area, it consists of four (4) client bedrooms, two (2) bathrooms, living room, dining room, kitchen, laundry area. Backyard includes outdoor activity area and the garage which was convered to an office.

LPA toured the facility with the Administrator at 9:30 am and observed the following:



Required postings were observed in the kitchen and dining area. The front entry is the main exit door and the secondary exit is located across the laundry areas which leads to the backyard. There are two fire extinguishers, one in the kitchen, one in the laundry area. Both fire extinguishers were serviced on 12/31/2024. Facility conducts monthly fire and safety drills, the last safety drill was conducted on 02/21/25. The physical plant appeared clean, sanitary and comfortable with no visible immediate hazards.


(Continued on 809C)
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2025
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: AMBITIONS - VERDUGO HOUSE 2
FACILITY NUMBER: 197608610
VISIT DATE: 02/24/2025
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Common Areas: Include a living room and a dining room. The common areas were properly furnished with table and just enough sitting/chairs, appropriate for the number of clients. Television set was observed in the living room. The dual smoke alarms and carbon monoxide detectors are interconnected. At 10:05 am the smoke/carbon monoxide alarms were tested and observed to function properly.

Kitchen: The kitchen appliances consisted of a refrigerator, stove, dishwasher and microwave and all the fixtures were observed to be functional. Knives, cutlery and sharp objects are stored in locked kitchen cabinets. The cleaning supplies were also locked in cabinet underneath the sink. LPA found a sufficient supply of perishable foods (2 days) and non-perishable food (7 days) supplies, with sufficient amount of dishes for the census of four (4).

Bathrooms: There are two (2) bathrooms designated for staff and residents’ use. All toilets and sinks are maintained in sanitary, operating condition. LPA observed proper grab bars and non-skid tiles in both bathrooms. Hot water temperature was measured at 121.7 and 119.7 degrees Fahrenheit.

Bedrooms: There are four (4) private bedrooms designated for clients' use. All of the bedrooms were properly furnished with appropriate chairs, beddings, closets/chest drawers with sufficient lighting. All client rooms were checked. Mattresses and box springs were in good condition and there were sufficient amount of linens in each room. Each bedroom has an exit door leading to the backyard.

Laundry Room: Laundry machines were located near bedrooms three (3) and four (4). All toxins are stored in a locked cabinet inaccessible to clients in care.

(Continued of 809-C)
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
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: AMBITIONS - VERDUGO HOUSE 2
FACILITY NUMBER: 197608610
VISIT DATE: 02/24/2025
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First-Aid Kit: There is a complete first-aid kit in the kitchen cabinet with all required supplies and with the first aid manual.

Surrounding grounds: Entry/exit gates and pathways were free of obstruction. The outdoor area was free of visible immediate hazards. No bodies of water were observed at the facility. There is ample patio space for outdoor activities. The furniture consists of chairs, table and umbrella, appropriate for outdoor use and was sufficient for number of clients.


Resident Files: A review of resident records to ensure compliance of licensing forms was conducted. Medications records for residents were also verified for accuracy of administration based on physician orders.

Staff Files: Staff files were reviewed to ensure all forms and training certificates are up to date.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit.

Exit Interview Conducted / A Copy of the Report provided to Administrator.


SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
LIC809 (FAS) - (06/04)
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