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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609006
Report Date: 12/20/2022
Date Signed: 12/21/2022 08:24:08 AM

Document Has Been Signed on 12/21/2022 08:24 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:VICTORY PLACE HOMEFACILITY NUMBER:
197609006
ADMINISTRATOR:AKHPARIAN, ANDREWFACILITY TYPE:
735
ADDRESS:6353 BABCOCK AVETELEPHONE:
(818) 585-0095
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 4CENSUS: 4DATE:
12/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Andrew AkhparianTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Angel Ascencio conducted an unannounced required annual visit
to the above facility. LPA Ascencio met with the Administrator Andrew Akhparian and Diana Gevorgyan and explained the reason for the visit. This home is vendor through North Los Angeles County Regional Center. This annual had a specific emphasis on infection control practices and procedures. At 10:54 a.m., LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards.

BEDROOMS: All client rooms are set up with beds, night stands, lamps, chests of drawers,
chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean
linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a
bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for
easy passage between the beds. In addition, no bedroom was used as a passageway to another
room, bath or toilet. There are five (5) total bedrooms – four (4) bedrooms are private rooms for clients use and one (1) room is master bedroom for staff.

RESTROOMS: There are 2 total bathrooms at the home. 1 is for client use, the other is a staff bathroom. The client bathroom has a shower with non-skid materials. The toilet and shower has grab bars. Hot water temperature was tested throughout the home and was within normal ranges between 105.0 F and 120.0 F.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and
good condition. At the time of the visit, common seating area and dining room furniture was
observed to be in good condition. Chairs were observed to be at least 6 (six) feet apart for social
distancing. There is an accessory dwelling unit within the property that is not licensed that is considered an additional staff room.
Continued on LIC 809 - C
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VICTORY PLACE HOME
FACILITY NUMBER: 197609006
VISIT DATE: 12/20/2022
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The LPA observed the required postings in the common hallway. Fire extinguishers
were observed to be serviced within the last year. The facility smoke alarm system and carbon monoxide
detector was tested and operated normally at the time of visit. Medications were observed to be locked in a
cabinet by the kitchen and contained at least 30 days of worth of medication. A locked staff room was observed that contained laundry supply. The backyard has a covered outdoor area equipped
with furniture for client use. The swimming pool gate was observed to be locked at the time of visit.

KITCHEN: Kitchen knives are stored in a locked cabinet in the kitchen. The supply of dishes,
utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees
Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of perishable and nonperishable
food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation
area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had
tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked staff room. No flies or other vermin were observed


INFECTION CONTROL: During today’s visit, the LPA spoke with Administrator regarding the
facility’s infection control practices at 11:00 a.m. There is 1 entry into the facility. Upon entry, the
facility has a central entry point for symptom screening. The LPA noted that the facility is allowing
visitors for both indoor and outdoor visitation. The LPA observed an adequate supply of Personal
Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The
facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation
room if the facility has a confirmed case of COVID-19. The facility does not have a confirmed case of
COVID-19 at this time. The facility’s policies and procedures as it pertains to infection control are adequate.
No citations were issued during today’s visit.

Exit interview conducted, and a copy of the report provided to Admin via email.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC809 (FAS) - (06/04)
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