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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609307
Report Date: 08/26/2021
Date Signed: 08/26/2021 03:20:35 PM

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:WELLBE HOMEFACILITY NUMBER:
197609307
ADMINISTRATOR:MKRTCHIAN, VAHEFACILITY TYPE:
740
ADDRESS:12936 WELBY WAYTELEPHONE:
(818) 414-0005
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:6CENSUS: 5DATE:
08/26/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Vahe Mkrtchian, AdministratorTIME COMPLETED:
03:18 PM
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An Informal Conference was conducted today in the Woodland Hills Adult and Senior Care Regional Office. The purpose of this Informal Conference is to discuss deficiencies cited during a required annual visit on 8/10/2021, specifically to discuss the LPA’s observation during the visit where a resident was locked in bedroom #2; the doorknob was tampered with so the resident could not exit the room.

In attendance included Licensing Program Manager Jeralyn Pfannenstiel, Licensing Program Analyst Salia Walker, and Administrator Vahe Mkrtchian.

Brief History: The facility was first licensed in 9/19/17, for a capacity of six residents.

LPM Pfannenstiel and LPA Walker discussed unsubstantiated complaint allegations from the past three years related to personal rights violations from 1/4/2018, 5/18/2018, 4/15/2019, 9/25/2020, and 1/7/2021. LPM and LPA communicated that the Department has received the Plan of Corrections in a timely manner, which included documentation for staff association, and photographs of proper doorknob. LPM Pfannenstiel discussed how the Administrator plans to stay in compliance and the best ways to work with the Department and Regional Center for additional support and assistance. The Administrator stated that the facility now has rotating staff to ensure sufficient staffing is available.

The Licensee was informed that Community Care Licensing (CCL) shall continue to monitor the facility with annual facility inspection visits and as often as necessary to ensure the Licensee's compliance with Title 22 Regulations. The Licensee was also informed that further citations and/or non-compliance may result in a Non-Compliance Conference with the Regional Manager.



Exit interview conducted and copy of today's report was provided to the Licensee.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
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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