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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608760
Report Date: 10/02/2024
Date Signed: 10/02/2024 01:54:09 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/02/2024 01:54 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:NOBLE CAREFACILITY NUMBER:
197608760
ADMINISTRATOR:ARMINE TAGARYANFACILITY TYPE:
740
ADDRESS:13300 ARMINTA STREETTELEPHONE:
(818) 616-2427
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 5DATE:
10/02/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:34 PM
MET WITH:Armine TagaryanTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a continuation of the required annual visit at 12:34 PM. LPA met with facility staff who contacted facility administrator Armine Tagaryan. Administrator arrived to the facility at 01:42 PM. Entrance interview conducted and the reason for the visit was explained.

During today’s visit LPA conducted a brief physical plant tour, interviews, and medication review.

INTERVIEWS: LPA interviewed one (1) resident and two (2) staff between 12:45 PM and 01:05 PM. The resident interviewed stated that the staff are nice and are attentive to their needs. The resident had no concerns with the facility. Both staff members interviewed were knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedure for suspected abuse. Both staff interviews were conducted with the assistance of the administrator acting as a translator.

MEDICATION REVIEW: Beginning at 01:06 PM LPA and the facility administrator conducted medication review for five (5) of five (5) residents. All medications reviewed were documented properly on their centrally stored medication and destruction record sheet. Medications are stored centrally and securely in a storage cabinet in the staff office. No deficiencies were observed during medication review.

No deficiencies were observed during today’s visit. Exit interview conducted and copy of the report was issued.

SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Trevor ByrneTELEPHONE: 747-444-6104
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024
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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