197609823-11-1-2023-31-AS-MCAA-CX6TJX-20231101144704

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609823
Report Date: 11/01/2023
Date Signed: 11/01/2023 02:47:48 PM

Document Has Been Signed on 11/01/2023 02:47 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:	ALALIK CARE HOME		FACILITY NUMBER:	197609823
ADMINISTRATOR:	ARZUMANYAN, HARUTYUN		FACILITY TYPE:	740
ADDRESS:	11152 WOODLEY AVE		TELEPHONE:	(818) 818-1808
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 6	DATE:	11/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:52 AM
MET WITH:	Harutyun Arzumanyan		TIME COMPLETED:	03:00 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	Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Harytyun Arzumanyan and explained the reason for the visit. At approximately 12:00pm, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide are dual. They are battery operated. The facility has two fire extinguishers. One is located in the hallway by resident rooms and the other is located in the kitchen. The charge date is 10/06/2023. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives are stored in a locked drawer in the kitchen. Bedrooms: There are six (6) bedrooms of which five (5) are designated for residents' use. The bedrooms, in use by residents were were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are four (4) bathrooms of which three (3) are designated for residents' use. One bathroom is designated for staff and guests. The bathrooms designated for the resident's use were properly supplied and had functional fixtures. Hot water temperature was measured at 112 degrees Fahrenheit. Cleaning supplies are being stored in the hallway bathroom. Common Areas: These included the living room and dining area. The common areas were properly furnished. The dining room has a large dining room table suitable to serve up to six (6) residents. There is a fireplace, that is non-operational. The auditory alarms on all exit doors were on and functional at the time of the visit. Staff work station is located at the corner of the living room.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALALIK CARE HOME	FACILITY NUMBER: 197609823
	VISIT DATE: 11/01/2023

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Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor
use. The outdoor area was free of hazards. The laundry room is locked. It is located by resident rooms #6 and #5. Detergents and cleaning supplies are kept locked inside the laundry room.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Medications are kept in a hallway closet, that is locked at all times. Medications and Medication Records were review for proper documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and A Copy of the Report Issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

LIC809 (FAS) - (06/04)

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