197609006-2-12-2025-29-AS-VCOY-DDTKFL-20250212065206

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609006
Report Date: 02/11/2025
Date Signed: 02/12/2025 06:53:36 AM

Document Has Been Signed on 02/12/2025 06:53 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	VICTORY PLACE HOME		FACILITY NUMBER:	197609006
ADMINISTRATOR/ DIRECTOR:	AKHPARIAN, ANDREW		FACILITY TYPE:	735
ADDRESS:	6353 BABCOCK AVE		TELEPHONE:	(818) 585-0095
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY: 4		CENSUS: 4	DATE:	02/11/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:10 AM
MET WITH:	Andrew Akhparian		TIME VISIT/ INSPECTION COMPLETED:	03:00 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 10:15 A.M. LPA met with administrators Andrew Akhparian and Diana Gevorgyan. This home is vendored by North Los Angeles Regional Center as a level 2 home. Entrance interview conducted.

Beginning at 11:05 A.M. the LPA, along with administrators toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations.

Fire extinguishers are fully charged and recently serviced 06/30/2024. Between 11:25 A.M. and 12:02 P.M. Carbon Monoxide detector and smoke detectors were tested, and all were functional at the time of the visit. No fire clearance concerns were observed. The facility does handle cash resources for some of the clients. Surety Bond is current.

COMMON AREAS: This includes the living room and dining room areas. LPA observed common areas to be clean and properly furnished at the time of the visit. The facility maintained a comfortable temperature. Facility provides sufficient space to accommodate both indoor and outdoor activities. LPA observed a working phone available for clients use whenever needed. LPA observed emergency backpacks and food located between the shared bathroom and two bedrooms.

BATHROOMS: There is a shared bathroom for client use. Restroom was observed to be equipped with slip resistant surfaces and contain slip resistant mats. At 11:10 A.M. the water temperature was measured and measured within the required range.

BEDROOMS: There are four (4) private bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. LPA observed one bedroom with a door leading to the backyard.

Continued on LIC 809-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VICTORY PLACE HOME	FACILITY NUMBER: 197609006
	VISIT DATE: 02/11/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from LIC 809

KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. LPA conducted a review of expiration dates on product labels. Cleaning supplies are located under the kitchen sink inaccessible to clients. At 11:25 A.M. hot water measured 115.8 degrees Fahrenheit. LPA observed two (2) complete first aid kits on top of the refrigerator.

STAFF ROOM: The staff room is locked an inaccessible to clients, employee and clients’ files are store there. Laundry detergents, other chemicals and sharps are locked inside the staff room. There is a bathroom for staff use only. LPA observed three (3) 33.8 oz x 6 pack of emergency water. Technical violation (TV) issued.

OUTDOOR SPACE: The perimeter of the facility is fenced. The front yard is free of obstructions. All passageways were observed to be clear. LPA observed missing tiles on the side wall along the hallway leading to the exit door. The administrator acknowledges the issue and states that due to financial hardship repairs of the damaged wall has been delayed. Additionally, LPA observed an uncovered downpipe drain on the ground. LPA observed one (1) locked side gate. Located at the back of the facility is an alternate dwelling unit (ADU) where staff will stay. The facility does contain a storage inaccessible to clients, where tools and other machinery are kept. Furthermore, LPA observed a shed where the washing and drying machine is kept. There is a pool that was observed to be locked and inaccessible at the time of the visit. LPA observed a ring doorbell and cameras on the outside of the property. LPA explained administrators that a waiver is required to have ring doorbell. LPA did not cite but advised the administrators to submit a waiver for the Ring doorbell due to the audio component, to update plan of operation and admission agreement.

MEDICATION REVIEW: Medications review began at 12:11 P.M. Only two clients are taking medication at the time of the visit. LPA reviewed medications for two (2) clients. Medications are centrally stored and locked in a cabinet in the living area; medications are labeled and checked for expiration dates. Pharmacy pre-fills the centrally stored medications and destruction record. LPA advise administrators to compare information on the form to confirm that is accurate. No errors observed during today’s medication review.

Continued on LIC 809-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VICTORY PLACE HOME	FACILITY NUMBER: 197609006
	VISIT DATE: 02/11/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from LIC 809-C

RECORD REVIEW: At 12:39 P.M. staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, IPPs and personal rights. Four (4) resident files were reviewed. Documents reviewed appeared complete and current. Two (2) staff files were observed to contain all required documents.

Additionally, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. Emergency disaster drills are conducted quarterly, with the last drill conducted on 01/30/2025.

LPA requested the following documents, Personnel Roster LIC (500), Liability Insurance, Resident Roster, and Surety Bond.

INTERVIEWS: During today's visit, LPA interviewed one (1) staff and one (1) client.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.)

Exit interview conducted. A copy of today's report and appeal rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

LIC809 (FAS) - (06/04)

Page: 2 of 4

Document Has Been Signed on 02/12/2025 06:53 AM - It Cannot Be Edited

Created By: Valeria Conway On 02/11/2025 at 02:10 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VICTORY PLACE HOME	FACILITY NUMBER: 197609006
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80087(a)

Building and Grounds

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by having missing tiles and a uncovered downpipe drain exposed which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/25/2025
	Plan of Correction
1 2 3 4	Administrator agrres to cover cover hole on the ground to prevent any clients from hurting themselves and schedule an appointment to missing tiles fixed.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Desaree Perera

LICENSING EVALUATOR NAME:

Valeria Conway

LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

LIC809 (FAS) - (06/04)

Page: 4 of 4