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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609003
Report Date: 07/15/2024
Date Signed: 07/15/2024 09:29:20 PM

Document Has Been Signed on 07/15/2024 09:29 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:ABEL&DAVIT HAYRAPETYAN'S COMMUNITY CARE FACILITYFACILITY NUMBER:
197609003
ADMINISTRATOR/
DIRECTOR:		GHAZARYAN, YERANUHIFACILITY TYPE:
735
ADDRESS:10185 SHARP AVETELEPHONE:
(323) 219-5454
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY: 4CENSUS: 3DATE:
07/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Yeranuhi Ghazaryan, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Leizl de la Cerra conducted an annual required visit and inspection of the facility. At 10:30AM Lilian Namatovu, Direct Support Professional met LPA at the entrance and LPA explained the reason for the visit. Administrator/Licensee Yeranuhi Ghazaryan arrived thereafter. The facility retains clients placed by North Los Angeles County Regional Center. The facility is a level 2.

Resident and Staff Records reviews and interviews: At approximately 11:30AM four 1:15PM three (3) out three (3) client records and five (5) staff records were reviewed to ensure compliance. Interview of one (1) staff was conducted. Interview of two (2) clients were conducted. A total of five (5) staff members including the Administrator have criminal background clearance, fingerprint cleared, have all required and current training and associated to the facility. LPA reviewed three (3) client files that are maintained at the facility. Physician's Report (including TB and Ambulatory Status), Consent For Medical Treatment, Individual Program Plan (IPP), Behavioral Reports, Client Cash Resources, Special Incident Reports, Client Personal Property and Clients Personal Rights observed. The record of each clients safeguarded cash/P&I was reviewed and amount was verified.

At 1:15PM LPA with the assistance of the administrator took a tour of the facility.

Common Area: LPA observed the living room and furniture to be clean and in good repair. The facility maintains a comfortable temperature at 72 degrees Fahrenheit. The air conditioner is operational. Smoke and carbon monoxide detectors are hardwired and at 1:20PM they were tested and deemed operational. One (1) Fire Extinguisher observed in the kitchen purchase date is 6/20/2024. Facility maintains a telephone land line and it was observed to be operational. Required postings were observed on the common area wall. The facility is fire cleared and last fire inspection was dated, 4-28-2024.

-Continue to LIC 809-C

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2024
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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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: ABEL&DAVIT HAYRAPETYAN'S COMMUNITY CARE FACILITY
FACILITY NUMBER: 197609003
VISIT DATE: 07/15/2024
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Kitchen: The kitchen appliances were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough food for at least three (3) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods and refrigerated foods are stored properly as well. Knives were stored in a locked upper cabinet in the kitchen. Food preparation areas are clean. Garbage can had tight fitting cover. Kitchen cleaning supplies were stored in a locked cabinet below the sink. Clients' dining table fits enough for six (6) people.

Bedrooms: There are five (5) bedrooms. 3 out of 3 client’s bedrooms were checked. Clients' rooms were properly furnished with appropriate dresser, night stand, chair, bed with clean linens, bed side lamp. Each room had sufficient lighting. Walls and floors were clean and in good condition. Extra towels, linens/beddings, toiletries and hygiene products are stored in the hallway closet accessible to clients.

Bathrooms: There are two (2) bathrooms designated for client use. The bathrooms were properly supplied and had functional fixtures and non-slip bath mats. The hallway bathroom hot water temperature was measured at 109.2 degrees

Surrounding Grounds: There is a covered patio with furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have any bodies of water. The garage is detached. Garage is used for storage, storing extra food supplies, a functional refrigerator which stored extra perishable items, toiletries and PPE supplies. Facility has a washer and dryer located inside the garage. Laundry chemicals are stored in the garage. The garage has a lock and will remain locked and inaccessible to clients in care.

LPA observed a 4 drawer cabinet locked up inside a closet that contains all the clients' records, the staff records and the clients' medications. LPA observed the storage closet has a keyed entry door knob which remains locked at all times and inaccessible to clients in care. First-aid has all proper items and is current. LPA checked the Surety bond which has a renewal date of 1-03-2024.

The facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed during today’s visit. Exit interview conducted. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC809 (FAS) - (06/04)
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