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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609624
Report Date: 11/19/2024
Date Signed: 11/19/2024 05:06:23 PM

Document Has Been Signed on 11/19/2024 05:06 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 INCFACILITY NUMBER:
197609624
ADMINISTRATOR/
DIRECTOR:		NAREK DAVTYANFACILITY TYPE:
735
ADDRESS:8526 CRANFORD AVETELEPHONE:
(747) 998-3399
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 4CENSUS: 4DATE:
11/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Narek Davtyan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 11/19/2024 Licensing Program Analyst (LPA) de la Cerra arrived at the facility listed above to conduct an unannounced annual inspection. LPA was greeted by caregiver, Aida. Administrator, Narek Davtyan was contacted and met LPA shortly thereafter and explained the reason for the visit.

At approximately 10:30AM LPA and the administrator toured the physical plant of the facility, and the following was observed.
This is an Adult Residential Facility(ARF), level 3 with an approved fire clearance for four (4)ambulatory clients.
Kitchen/ Dinning areas: The kitchen was observed to be clean and clear of clutter. Appliances and fixtures were functioning properly. LPA observed a sufficient amount of 2-day perishable and 7-day non-perishable supply of food; properly stored. Dining areas had appropriate table and chairs to sit the capacity of the facility. LPA observed knives kept in a locked kitchen drawer.

Living rooms: The facility's living room appeared to be clean and properly furnished. Fireplace was observed to be closed and secured with screens. LPA observed a television and games for clients to use.

Laundry: Laundry room is located by the kitchen area. Detergents, extra cleaning supplies, and toiletries where observed locked in a closet in the laundry room. Washer and dryer were observed operational.

Bathrooms: The facility has two (2) full bathrooms for client use and one (1) half bath for staff use. The LPA took hot water temperature from one (1) out two (2) client bathrooms and temperature read between 110 degrees Fahrenheit and 118 degrees Fahrenheit, which is within regulation. LPA observed both bathrooms to be clean and properly supplied with toilet paper, hand soap, paper towels and trash bins with lids. LPA also observed both client bathrooms have the appropriate non-slip mats and grab bars,

Continued on to LIC809-C
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: MAGIC VILLA INC
FACILITY NUMBER: 197609624
VISIT DATE: 11/19/2024
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Bedrooms: There are a total of five (5) bedrooms, two (2) of which are designated for staff. LPA inspected three (3) out of three (3) client bedrooms. Bedroom #3 is for one client, bedroom #4 is for one client and bedroom #5 is a shared bedroom for 2 clients. LPA observed all rooms to be properly furnished with bed, appropriate night stand, lamp, chair, clean beddings, sufficient lighting and a walk in closet in all three (3) rooms. LPA observed extra linens in the hallway outside the bedrooms.

Garage and Surrounding Grounds:
Garage is detached from the main house, LPA observed gym equipment inside the garage. It is inaccessible to clients. Entry and exits were free of obstructions. There is a covered patio with appropriate furniture for clients to use. There are no bodies of water at this facility.

LPA observed the smoke alarms and Carbon Monoxide sensors are installed throughout the facility, hardwired, and interconnected. Smoke and Carbon monoxide detectors were tested at 11:30AM and observed to function properly. Fire extinguisher was fully charged with purchased date of 10/22/2024. LPA observed required facility postings in the hallway. The first aid kit was complete. Client medications and facility files are in a locked cabinet by the dining area. LPA observed the facility telephone on the living room and is operational.

Facility Records: At 1:00PM LPA conducted records review of facility staff and clients. LPA reviewed four (4) out four (4) client records and three (3) staff records were reviewed to insure compliance.

Medications: At approximately 2:00PM medications and medication records were reviewed for proper documentation. Centrally Stored Medication Records are pre-filled by pharmacy and facility keeps a Medication Administration Record (MAR).

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during todays visit. Exit Interview Conducted. A Copy of the Report Issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC809 (FAS) - (06/04)
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