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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608954
Report Date: 11/28/2022
Date Signed: 11/28/2022 11:07:47 AM


Document Has Been Signed on 11/28/2022 11:07 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:LIEBELOVE CARE INCFACILITY NUMBER:
197608954
ADMINISTRATOR:GALINA MELKONYANFACILITY TYPE:
740
ADDRESS:6500 QUARTZ AVENUETELEPHONE:
(747) 888-9984
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 3DATE:
11/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Galina MelkonyanTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Ashley Smith arrived at the facility unannounced to conduct a required annual visit at 9:45 a.m. The LPA met with Administrator Galina Melkonyan and explained the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: Knives and chemicals were locked inaccessible in the kitchen cabinets. Appliances were in operable condition. The facility had a sufficient supply of perishable and non-perishable food. BEDROOMS: Bedrooms were furnished appropriately; beds were observed with clean linens and rooms had sufficient lighting. All direct exits were clear, and no obstructions were noted. RESTROOMS: Restrooms were clean and sanitary with grab bars and non-skid surfaces. At 10:00 a.m., water temperature measured at 115.5 F. Restrooms were fully stocked. Hand-washing signs were observed in all restrooms. FILES: The LPA reviewed resident files at 10:05 a.m. All resident files were in order at the time of the visit. The LPA reviewed staff files at 10:35 a.m. All staff files were in order at the time of the visit. COMMON SPACES: There was a hallway closet with extra linens and towels. Smoke and common monoxide detector were tested at 11:00 a.m. and were operable at that time. Fireplace in the living room was covered. Medications and files were locked and inaccessible in the kitchen cabinet. Fire extinguisher was fully charged. The backyard had furniture and a covered area for resident use. The garage was attached but is kept locked. The washer and dryer were in the garage, along with additional supplies.

INFECTION CONTROL: There was a central entry point for screening and temperature checks. The LPA was appropriately screened upon entry into the facility. Staff were wearing appropriate face coverings. Infection Control signs were observed at the entrance into the facility. The facility’s cleaning protocol was sufficient. There was record of staff and resident vaccinations. The LPA discussed changes around testing, visitation and vaccine requirements. The facility's procedures as it pertains to infection control are adequate.

No deficiencies issued at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2022
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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