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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609655
Report Date: 03/10/2022
Date Signed: 03/10/2022 01:14:59 PM


Document Has Been Signed on 03/10/2022 01:14 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:TNA RESIDENTIAL CAREFACILITY NUMBER:
197609655
ADMINISTRATOR:AKMAKCHYAN, MARIFACILITY TYPE:
740
ADDRESS:18627 LANARK STREETTELEPHONE:
(818) 593-9292
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 3DATE:
03/10/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Mari AkmakchyanTIME COMPLETED:
01:25 PM
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At approximately 11:45 AM on 03/10/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual continuation visit. LPA met with licensee and disclosed the reason for the visit. LPA and licensee toured the facility inside and out.

Census: 3 residents, 2 staff, 1 licensee

There is a white perimeter fence with two gates at the front of the facility. Licensee noted one gate is locked and the other gate is opened by remote controlled. LPA advised that one gate should remained unlocked for the personal rights of residents. LPA noted the Licensee can obtain a waiver through the department if they wish to keep the gate locked.

LPA toured both resident bathrooms. The knob to the faucet of Bathroom #1 was fixed. LPA tested water temperature to be 119.8 degrees Fahrenheit. In Bathroom #2, a grab bar was installed by the toilet.

LPA and licensee toured the unit adjacent to the facility which was listed on the facility sketch. LPA observed functioning smoke detectors and no hazardous materials.

At approximately 12:15 PM, LPA and licensee reviewed the facility’s mitigation plan. The facility’s designated visitation area is in the back yard. Staff clean the facility approximately 5 times per day. The facility has had no positive cases of COVID-19.

During today's visit, facility is in compliance with Title 22 Regulations, no citations are issued.

LPA cleared deficiencies for the faucet knob, water temperature, and grab bar. conducted exit interview and issued a copy of the report.

SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2022
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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