197609624-11-27-2023-31-AS-CALH-CXYW5R-20231127155935

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609624
Report Date: 11/27/2023
Date Signed: 11/27/2023 04:00:05 PM

Document Has Been Signed on 11/27/2023 04:00 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:	MAGIC VILLA INC		FACILITY NUMBER:	197609624
ADMINISTRATOR:	NAREK DAVTYAN		FACILITY TYPE:	735
ADDRESS:	8526 CRANFORD AVE		TELEPHONE:	(747) 998-3399
CITY:	SUN VALLEY	STATE: CA	ZIP CODE:	91352
CAPACITY: 4		CENSUS: 3	DATE:	11/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Administrator Narek Davtyan		TIME COMPLETED:	04:15 PM

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On 11/27/2023 at 02:00 PM, Licensing Program Analyst (LPA) Christopher Alemoh conducted an unannounced Required – Annual Continuation Inspection and met with Administrator Narek Davtyan. No residents present and two (2) staff were present during this inspection.

Facility has been approved for a capacity for Four (4) residents. The Annual Licensing Fees are current.

The home consists of 1 floor level with: 4 resident rooms, 3 restrooms, kitchen, dining room, and laundry room and 1 staff room.

At 02:20PM the administrator accompanied LPA inside and outside the facility during facility plant tour. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards.

Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises.

Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured at 111F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. LPA toured the shared hallway restroom temperature measured at 112 degrees Fahrenheit.

Common areas were clean and clear of hazards, doorways were free of obstructions. Facility Temp at 70 degrees Fahrenheit.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023

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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: MAGIC VILLA INC	FACILITY NUMBER: 197609624
	VISIT DATE: 11/27/2023

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LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher last serviced 10/04/2023 was observed in the kitchen area. LPA tested all carbon monoxide detectors and smoke detectors located in the kitchen area. Both devices were functional. LPA observed that all bedrooms and hallways are equipped with a carbon monoxide and smoke detector.

LPA toured the Laundry Room adjacent to the kitchen. Both appliances are in good working order. Cleaning chemicals and solutions are stored and locked in cabinets above machines.

At 02:55 PM Three (3) staff records were reviewed, 3 out of 3 staff records had current first aid certificates and had required criminal record clearances or criminal record exemptions.

At 03:40 Four (4) resident records were reviewed and, 4 out of 4 client records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans.

Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023

LIC809 (FAS) - (06/04)

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