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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608749
Report Date: 03/05/2024
Date Signed: 03/05/2024 06:22:28 PM

Document Has Been Signed on 03/05/2024 06:22 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: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:
03/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:57 AM
MET WITH:Anait Domio, AdministratorTIME COMPLETED:
06:30 PM
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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the entire CARE Inspection Tool. LPA Yee was let into the home by Ofelya Zakaryan, Staff. Anait Domio, Administrator was contacted by staff and she arrived at 10:33am to conduct the visit. Marine Hakobyan, Licensee, also participated in today's visit. The reason for today's visit was explained.

The home is a single story family home consisting of a living room, dining room, kitchen, 3 bedrooms of which one is used for live-in staff, 2 full bathrooms, a laundry room and a attached garage that is used as office and storage. The facility is fire cleared for 4 AMBULATORY clients. The facility is vendorized by the North Los Angeles Regional Center as a Level 3 home.

All 12 domains of the CARE Inspection Tool was reviewed, Client and Staff files were inspected and a tour of the entire facility, inside and outside was toured on today's visit.

The following were observed during today's visit:
  • The living room, dining room and kitchen had the appropriate furnishings and kitchen equipment for the four clients. The fireplace located in the living was covered with a metal fire screen.
  • Bedroom #1 and Bedroom #3 had the required bed, night stand, lamp, chair and shared dressers and closet for the four clients in care.
  • Bedroom #2 is designated for the live-in staff and was toured
  • The client beds were observed with mattress cover, fitted sheets and comforters and one with a blanket. Per the Administrator, the clients do not want flat sheets or want blankets on their beds. Flat sheets and blankets were observed in the linen closet. Also observed were towels and extra linens.
  • The common bathroom located by the client bedrooms, designated for staff use consists of a deep bath tub, a toilet and a 2 sink vanity.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2024
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 2
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: AMERICAN SWEET HOMES
FACILITY NUMBER: 197608749
VISIT DATE: 03/05/2024
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  • The common bathroom located by the front door is equipped with a shower stall, a sink and a toilet.
  • The water temperature was tested in the front bathroom and it tested 119.5 degrees Fahrenheit
  • The smoke/carbon monoxide combination detectors were tested and were operational
  • The only smoke detector located in the kitchen was inspected on 9/20/23.
  • The appropriate posters were observed by the front door including the facility license
  • Night lights were observed in the hallways
  • Perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days were observed. Recommendation was made to purchase additional non-perishable foods to ensure that the quantity is not depleted as it is being used.
  • The facility has a current surety bond for $6,000 and general liability insurance for $1,000,000.00 per occurrence and $3,000,000.00 general aggregate.
  • a table and chairs were observed in the covered patio located directly outside the dining room.
  • Trash cans stored in the front of the facility were observed to be tightly sealed
  • Per tour of the facility, inside and outside, front yard and backyard, the facility was observed to be clean and well maintained. No bodies of water were observed.
  • Facility telephone number was verified and matches the telephone number currently noted on the facility profile - (818)646-0266.
  • Ownership of the facility was verified and there has been no change in ownership



No deficiencies were cited on today's visit.


Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
LIC809 (FAS) - (06/04)
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