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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609793
Report Date: 09/28/2022
Date Signed: 09/28/2022 01:30:14 PM


Document Has Been Signed on 09/28/2022 01:30 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. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:SAINT CLAIR ASSISTED LIVINGFACILITY NUMBER:
197609793
ADMINISTRATOR:EMMA ARUTIUNIANFACILITY TYPE:
740
ADDRESS:6608 SAINT CLAIR AVETELEPHONE:
(818) 983-2224
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:6CENSUS: 5DATE:
09/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Emma ArutiunianTIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a required annual visit. This annual had a specific emphasis on infection control practices. The LPA initially met with staff Ovsanna Norentsayan, whom contacted Administrator Emma Arutiunian. The LPA explained the reason for the visit. The LPA toured the facility to ensure there are no health and safety hazards and to ensure compliance. Residents were well groomed and communicated no concerns to the LPA during the tour.

KITCHEN: Knives and chemicals are locked inaccessible. Appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: Bedrooms were furnished with clean linens and sufficient lighting. Rooms were clean and clear of obstructions. RESTROOMS: Restrooms were clean and sanitary with grab bars and non-skid surfaces. At 12:25 p.m., water temperature measured at 116.2 F. Restrooms were fully stocked. Hand-washing signs were observed. COMMON SPACES: The facility maintained a temperature of 75 degrees. Fireplace in the living room was covered. Fire extinguishers were fully charged and purchased 4/10/2022. The backyard and exterior area of the facility had furniture and a covered area for resident use. No obstructions observed in the exterior or interior. The converted garage/ADU in the backyard was empty; no furniture observed and no one living in the unit at this time. No bodies of water noted. OTHER: All staff were fingerprint cleared and associated to this location.

INFECTION CONTROL: There is a central entry point for screening and temperature checks. Staff were wearing appropriate face coverings. Signs were posted that promoted good hand hygiene, physical distancing, and cough/sneeze etiquette in the living room. The facility’s cleaning protocol is sufficient. There was record of staff and resident vaccinations. The facility can isolate a person if there was a confirmed case of COVID-19. The LPA discussed department changes around testing, visitation and vaccine requirements. The policies and procedures pertaining to infection control were adequate.

No deficiencies. Exit interview conducted. Email information was updated. A copy of the report was issued.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2022
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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