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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609003
Report Date: 02/19/2025
Date Signed: 02/21/2025 10:16:06 AM

Document Has Been Signed on 02/21/2025 10:16 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 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: 4DATE:
02/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Emily Baryayebwa, AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 2/19/2025 at 2:00PM Licensing Program Analyst (LPA) de la Cerra arrived at the facility listed above to conduct an unannounced annual inspection. LPA was greeted by caregiver, Mathias Kamara. The Administrator, Emily Baryayebwa was contacted and LPA explained to the administrator the reason for the visit. Administrator arrived shortly thereafter.

This home is designed to operate as a Level 2 Adult Residential Facility (ARF), this facility's fire clearance was approved on 08/10/2016 for four (4) ambulatory developmentally disabled clients.

LPA and administrator, toured the facility and the following was observed. The facility is a single-story building that consist of five (5) bedrooms and two (2) bathrooms. The facility maintains a comfortable temperature at 74°F. LPA observed one (1) fire extinguisher, fully charged and purchased on 6/20/2024. LPA observed the required facility postings in the dining area. The facility provides a telephone for clients to use and LPA observed the phone to be operational.

LPA observed dual smoke/carbon monoxide detectors that are hard wired and interconnected. Smoke detector was tested @4:15pm and was observed to function properly.

Kitchen Area: The main area kitchen where clients’ meals are prepared was observed to be clean. Appliances were clean and functional. LPA observed a sufficient amount of 2-day perishable and 7-day non-perishable supply of food and were properly stored. LPA observed knives kept in a locked cabinet, inaccessible to clients. Trash bin has a covered lid. The dining table by the kitchen area had the appropriate table and chairs to accommodate the clients at this facility.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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: 02/19/2025
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Resident, Staff & Facility Records review: At 2:15PM LPA reviewed (4) out four (4) client records and two (2) staff records were reviewed to ensure compliance. LPA observed a 4 drawer cabinet locked up inside a storage closet that contains all the clients' records, the staff records and the clients' medications.
LPA observed the storage closet where the 4 drawer cabinet is located has a lock and is inaccessible to clients in care.

At approximately 3:00PM medications and medication records were reviewed for proper documentation. Facility keeps a Medication Administration Record (MAR). And, P&I was reviewed and amount was verified. LPA checked the Surety bond which has a renewal date of 1/01/2028 and Liability Insurance Certificate shows a policy expiration of 6/21/2025. Fire drill was conducted on 10/31/24. First-aid has all proper items and is current.

Bedrooms: The facility has five (5) bedrooms. Four (4) bedrooms are designated for client use and on (1) for staff use. Clients' rooms were properly furnished with appropriate dresser, night stand, chair, bed with clean linens, and a 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 and toiletries. 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.

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: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC809 (FAS) - (06/04)
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