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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608749
Report Date: 02/09/2023
Date Signed: 02/13/2023 08:37:58 AM

Document Has Been Signed on 02/13/2023 08:37 AM - 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 NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:AMERICAN SWEET HOMESFACILITY NUMBER:
197608749
ADMINISTRATOR:ANAIT DOMIOFACILITY TYPE:
735
ADDRESS:6932 TOBIAS AVENUETELEPHONE:
(818) 646-0266
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 4CENSUS: 4DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marine Hakobyan, AdministratorTIME COMPLETED:
12:45 PM
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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required annual inspection and was let into the home by Ofelya Zakaryan,Staff at 9:05am. The annual inspection was conducted with emphasis on infection control practices and procedures. Marine Hakobyan, Licensee/backup Administrator, was contacted by staff and arrived at 9:32am with Anahit Domio, Administrator to conduct the visit. The reason for today's visit was explained.

The home is a single storey home consisting of 3 bedrooms, 2 full bathrooms, a living room, kitchen, dining room, a laundry room and a attached garage. The home is fire cleared for 4 ambulatory clients. The home is vendorized by North Los Angeles Regional Center and is a level 3 home.

Upon arrival at the facility, LPA Yee observed signs posted on the front door and at the entrance regarding wearing masks before entering and to stay away if you are sick, hand washing, symptoms of Covid-19, Cough Etiquette. LPA's Yee's temperature was taken by staff upon entry. The facility has plenty of Personal Protection Equipment (PPE) stored in the garage and a mitigation plan. Hand sanitizers were observed in the living room, kitchen and client bedrooms. As of this visit, the facility has been able to keep the clients Covid-19 free.

continued on LIC809-C
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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 NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: AMERICAN SWEET HOMES
FACILITY NUMBER: 197608749
VISIT DATE: 02/09/2023
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A tour of the facility, inside and outside, was conducted together with the Licensee and Administrator at 11:06am. The following were observed:
  • The common areas and client rooms were observed to be clean and contained all the required furniture.
  • Sufficient bed linens and towels were observed
  • The only fire extinguisher located in the kitchen was full and last inspected on 1/14/23
  • The interconnected combination smoke and carbon monoxide detectors were tested and were operational
  • The facility has the required 2 day perishable and 7 day non-perishable supply of foods,
  • Toxins and sharp knives were locked up
  • Medications were locked in a cabinet in the kitchen
  • The water was tested at 12:14pm in the kitchen and front client bathroom and read 115 degrees Fahrenheit.
  • The front and backyard were observed to be well maintained. The backyard has a covered patio with plenty of sitting and a table with an umbrella. No bodies of water was observed.


No deficiencies were cited on today's visit.

Exit interview was conducted with the Licensee and Administrator. Due to printer issues, a copy of this report will be emailed to the Administrator.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC809 (FAS) - (06/04)
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