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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609594
Report Date: 02/27/2024
Date Signed: 02/27/2024 04:51:42 PM


Document Has Been Signed on 02/27/2024 04:51 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:SPARR HEIGHTS ESTATES SENIOR LIVINGFACILITY NUMBER:
197609594
ADMINISTRATOR:LEWIS, ERNESTFACILITY TYPE:
740
ADDRESS:2640 HONOLULU AVETELEPHONE:
(818) 248-6737
CITY:MONTROSESTATE: CAZIP CODE:
91020
CAPACITY:131CENSUS: 58DATE:
02/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Helen Kirkorian, Business Office ManagerTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced Required 1 year inspection to the facility.

LPA met with Helen Kirkorian, Business Office Manager and the purpose of the visit was discussed.

LPA conducted a physical plant tour of the facility.

There is one main entrance being utilized at the facility.

The facility consists of one main building. The Independent Living section of the facility is on the top floor and the Memory Care Unit is located on the bottom floor.

The facility has a capacity for 131 residents. Currently 58 rooms are being occupied. Common areas were checked for cleanliness. Food Service/Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. The residents rooms are adequately furnished with appropriate furniture and lighting system.

The facility maintains a comfortable temperature at 78 degrees. The smoke detectors are hardwired and interconnected and observed to be operational. There are carbon monoxide detectors in the facility. Fire extinguishers are located throughout the facility and were last serviced in January of 2024.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024
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 2


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: SPARR HEIGHTS ESTATES SENIOR LIVING
FACILITY NUMBER: 197609594
VISIT DATE: 02/27/2024
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The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the showers and toilets. The hot water temperature was measured at 120 degrees F.

Medications-LPA observed medication carts in the nursing station to be locked and inaccessible to residents. There is one ( 01) complete first aid kit.

Exit interview conducted. A copy of this report was issued and signature obtained.
No deficiencies were issued at this time
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC809 (FAS) - (06/04)
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