197609845-12-27-2024-29-AS-EMOY-DCCVV5-20241227154546

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609845
Report Date: 12/27/2024
Date Signed: 12/27/2024 03:45:56 PM

Document Has Been Signed on 12/27/2024 03:45 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	SWEET HOME SENIOR LIVING FACILITY		FACILITY NUMBER:	197609845
ADMINISTRATOR/ DIRECTOR:	KAREN BABAYAN		FACILITY TYPE:	740
ADDRESS:	6456 VARNA AVENUE		TELEPHONE:	(818) 666-7598
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91401
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	12/27/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Marine Bekyan - Administrator Licensee representative, Lusine Srmikyan		TIME VISIT/ INSPECTION COMPLETED:	03:55 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) Erica Mosley arrived at the facility unannounced to conduct a required annual visit. At 1:00 p.m., the LPA met with staff and explained the reason for the visit. LPA met with Administrator Marine Bekyan and the reason for the visit was explained. Licensee representative, Lusine Srmikyan arrived later during the visit. At 1:08 p.m., the LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA observed the kitchen and dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. At 1:14 p.m., hot water measured at 108.9-degree Fahrenheit. Medications and first aid kits are located in a locked kitchen drawer. BEDROOMS: The facility is a single-story residential home with four (4) bedrooms and three (3) bathrooms for resident's use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid surfaces. At 1:19 p.m., hot water measured between 108.3 and 109.8-degree Fahrenheit all within the required range. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout bathrooms and facility to promote hand washing. DOCUMENTS: LPA obtained the following documents, LIC 9020 Resident roster, LIC 500 Personnel report, and current liability insurance. Report continued on LIC 809-C.

Kasandra Lopez	TELEPHONE: (818) 596-4343
Erica Mosley	TELEPHONE: (747) 230-3909
	DATE: 12/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024

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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SWEET HOME SENIOR LIVING FACILITY	FACILITY NUMBER: 197609845
	VISIT DATE: 12/27/2024

NARRATIVE

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Report continued from LIC9099....
COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 05/14/2024. At 1:22 p.m., fire alarms/ carbon monoxide detectors were tested and functioned properly. Laundry units are located in one of the hallways. Night lights were present in the hallways and passages. The last emergency disaster drill took place on 09/20/2024 and are conducted quarterly, with their next one scheduled for Monday, December 30th. Activities were observed in the common areas.

OUTDOOR SPACE/ GARAGE: At 1:28 p.m., the LPA observed the back patio which has a covered outdoor area for resident use including a table and chairs. There is a self latching gate on the side of the house designated for an emergency exit. There are no bodies of water on the premises. LPA observed an adequate amount of emergency food and water. Garage is used as an office and is maintained locked at all times.

RECORD REVIEW: Starting at 1:32 p.m., the LPA reviewed resident records for five (5) out of five (5) residents. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, and consent forms. All files were in order. The LPA conducted a personnel file review for (3) staff regularly scheduled and reviewed for, but not limited to: health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files in order.

MEDICATION AUDIT: A medication audit for five (5) residents was conducted at 2:29 p.m. and the following was observed. Medications are centrally stored and locked in a locked drawer in the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. No medication errors observed at this time.

INTERVIEWS: Two (2) staff interviews were conducted. Interviews revealed that staff are knowledgeable in resident rights, forms of abuse, and reporting procedures. Two (2) resident and visiting family member interviews were conducted during the inspection. No concerns noted at the time of the visit.

No deficiencies were cited during today’s inspection. Exit interview conducted. A copy of the report reviewed and provided.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Erica Mosley	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2024

LIC809 (FAS) - (06/04)

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