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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609793
Report Date: 09/20/2021
Date Signed: 09/20/2021 11:31:47 AM

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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:SAINT CLAIR ASSISTED LIVINGFACILITY NUMBER:
197609793
ADMINISTRATOR:ANI A. GABRIELIANFACILITY TYPE:
740
ADDRESS:6608 SAINT CLAIR AVETELEPHONE:
(818) 983-2224
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:6CENSUS: 6DATE:
09/20/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Ovsanna Norentsayan, DesigneeTIME COMPLETED:
11:35 AM
NARRATIVE
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Licensing Program Analyst (LPA) Salia Walker conducted an announced Case Management-Deficiencies visit today to issue a citation that was inadvertently omitted during a conducted annual visit on 09/14/2021. The LPA met with Designee Ovsanna Norentsayan and explained the reason for the visit. At 10:01 a.m., LPA Walker conducted a physical plant tour.
On 09/14/2021, LPA Walker conducted a required annual visit where the following deficiency was included on the LIC809 evaluation report but was inadvertently not cited on the LIC809-D page. At 12:06 p.m., the LPA identified there were two (2) tenants living in the facility’s Garage. Tenant #1 (T1) stated that they were renting the garage, and that they live there. The Administrator and the LPA conducted a tour of the converted garage, which included a kitchenette, bedroom, and private bathroom, to ensure there were no residents living in the garage. Tenant #2 (T2) was in the garage converted bedroom. The LPA confirmed that these individuals were not associated to this facility nor background cleared. No further information was provided by T1 or T2. The LPA advised the Administrator that this is a Fire Clearance Violation and a criminal record clearance violation, and the garage is not cleared for habitation. The LPA inquired whether the facility has a permit with Building and Safety to have the garage converted. The Administrator stated she had no knowledge of whether there was a permit obtained, and had no knowledge of tenants residing in the garage. The Administrator stated she would contact the Licensee representative/ property owner to obtain additional information. The Administrator stated she was not able to reach the Licensee representative/ property owner.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code.
Civil penalties issued.
Exit interview conducted. A copy of the report and appeal rights was provided.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SAINT CLAIR ASSISTED LIVING
FACILITY NUMBER: 197609793
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/20/2021
Section Cited

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87203 Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.
This requirement is not met as evidenced by:
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Based on observation, the licensee did not comply with the section cited above, as the facility's garage was converted without permit from Building and Safety clearing for habitation, which poses an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2021
LIC809 (FAS) - (06/04)
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