197609077-2-17-2024-31-AS-MCAA-D2JRY6-20240217122550

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609077
Report Date: 02/17/2024
Date Signed: 02/17/2024 12:25:56 PM

Document Has Been Signed on 02/17/2024 12:25 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	ALL ABOARD!		FACILITY NUMBER:	197609077
ADMINISTRATOR:	ANDRANIK TER-NERSESIAN		FACILITY TYPE:	740
ADDRESS:	10629 COLLETT AVE		TELEPHONE:	(818) 934-7146
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 6	DATE:	02/17/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Sirun Harutyunyan		TIME COMPLETED:	12:30 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) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Sirun Harutyunyan and explained the reason for the visit. The administrator, Andranik Ter-nersesian was called and advised of the visit. At 9:15am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are hardwired and interconnected. There is a carbon monoxide detector installed at the facility and equipped with fire sprinkler system. All doors are equipped with auditory alarm. The fire extinguisher is located at the staff workstation, located by the kitchen and front entrance. LPA observed two complete first aid kits during the inspection. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. Bedrooms: There were four (4) bedrooms designated for residents' use. Two bedrooms are shared rooms and two bedrooms are private. All four bedrooms were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms. One (1) bathroom is designated for staff. Bathroom designated for resident use is properly supplied and had functional fixtures. Hot water temperature was measured at 105 degrees Fahrenheit. No cleaning supplies observed accessible in the bathroom during the day's inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. The floors was clean. Entrance/exits were clear of obstruction.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2024

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALL ABOARD!	FACILITY NUMBER: 197609077
	VISIT DATE: 02/17/2024

NARRATIVE

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Surrounding Grounds: Passageways along the entrance, sides and back of the home were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area is located outside of the home, at the side, opposite the kitchen. Both washer and dryer were covered and not in use at the time. LPA did not observe any cleaning supplies.

Office/Staff Workstation: The staff workstation is located near the kitchen, at the front entrance.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Medication and Medication Records were review for proper documentation. Client insulin observed in a locked case in the refrigerator. The disposable container, where the used needles are disposed of, is kept locked in the medicine cabinet.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a copy of this Report Issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2024

LIC809 (FAS) - (06/04)

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