<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609666
Report Date: 02/04/2019
Date Signed: 03/09/2023 02:48:24 PM


Document Has Been Signed on 03/09/2023 02:48 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
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:ROYALTY ASSISTED LIVING IIFACILITY NUMBER:
197609666
ADMINISTRATOR:AVETIAN, LIDUSHFACILITY TYPE:
740
ADDRESS:17326 LOS ALIMOS STTELEPHONE:
(818) 436-9088
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 0DATE:
02/04/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Lidush AvetianTIME COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
 A pre-licensing announced visit was conducted on this date by Licensing Program Analysts (LPAs) Gary Tan and Brian Balisi. During the visit LPAs met with the applicant/licensees Lidush Avetian and Estella Avetian.

LPA conducted a physical plant inspection tour, inside and outside of the facility. The facility is one story home. The facility has a fire clearance approved for six (6) residents (1) bedridden may be in room #1 or #2, but only (1) bedridden client at a time. Bedroom #3 is for Ambulatory only. There are (3) direct exits, (2) in the front and (1) in the back, which is illustrated on the facility sketch. Rooms one through three (1-3), will be designated for the client's use. Rooms were observed with a mattress, sufficient lighting and closet space. Sufficient linen and bedding were observed maintained. Facility has a fire extinguisher located in the dining room area. Carbon Monoxide and Smoke detectors are hard-wired and interconnected. They are located throughout the facility. Centrally stored medications will be maintained in a cabinet in the office near the dining room. A complete first aid kit is maintained in the dining area. Medical records will be kept in a cabinet in the dining area.The laundry area is located in a room leading to the garage through the kitchen. The laundry area and the garage was observed to be locked and inaccessible to residents. The garage is attached to the house but the only access is through the kitchen and laundry room. The garage was also observed to be converted into a storage space. Laundry detergents and other cleaning supplies are kept in the laundry area. During inspection, LPA observed the hot water in the bathroom is measured at 105.9 degrees F. Bathtub’s/shower’s have grab bars and non-skid mats. The Common/ dining room area were observed to be clean and safe for the client's use.

Pursuant to Title 22, Division 6, facility observed to be compliant with regulation. No corrections needed at this time. A copy of this report will be forward to the application specialist with LPA's recommendation for licensure. Exit interview conducted and a copy of this report given to the applicant/licensee and administrator.

SUPERVISOR'S NAME: Alex EstradaTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Brian BalisiTELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2019
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 1