197609851-11-7-2023-29-AS-EPEI-CXCTWU-20231107140606

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609851
Report Date: 11/07/2023
Date Signed: 11/07/2023 02:06:23 PM

Document Has Been Signed on 11/07/2023 02:06 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:	VH CARE		FACILITY NUMBER:	197609851
ADMINISTRATOR:	VAHAGN HARUTYUNYAN		FACILITY TYPE:	740
ADDRESS:	13945 SYLVAN STREET		TELEPHONE:	(818) 322-8838
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91401
CAPACITY:	6	CENSUS: 5	DATE:	11/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Vahagn Harutyunyan, Administrator		TIME COMPLETED:	02:15 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) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 12:00 p.m., the LPA met with the Administrator and explained the reason for it visit. At 12:10 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/dining area. Knives are stored in a locked kitchen cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 12:25 p.m., hot water measured at 105.1-degree Fahrenheit. Medications and first aid kit are located in a locked kitchen cabinet. Cleaning solution items were inaccessible and locked away inside a kitchen cabinet. BEDROOMS: The facility is a single-story residential home with three (3) bedrooms and two (2) bathrooms for resident's use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The facility has a sufficient supply of clean towels, blankets and linens. 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 materials. At 12:17 p.m., hot water measured between 105.2 and 108.1-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. OUTDOOR SPACE: At 12:13 p.m., the LPA observed the back patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. Passageways were free and clear from obstruction. There are no bodies of water on the premises. GARAGE: The garage is attached to the house and remains locked and inaccessible to residents. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the garage. The laundry units are located inside the garage. The property is connected to a city approved ADU. The individuals living in the home do not have access to this facility. Continued on LIC-809-C.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

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

FACILITY NAME: VH CARE	FACILITY NUMBER: 197609851
	VISIT DATE: 11/07/2023

NARRATIVE

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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 within the year. At 12:23 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Signs are posted throughout facility to promote handwashing, and cough/sneeze etiquette.

Between 12:25 p.m. and 12:32 p.m., the LPA conducted interviews with two (2) out of five (5) residents and one (1) staff.

RECORD REVIEWS: Between 12:35 p.m. and 12:55 p.m., the LPA conducted a personnel file review for all staff regularly scheduled and reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR certificates, and staff training records. All files were in order. Fire and earthquake drills conducted within the last 6 months. Additionally, the LPA obtained copy of valid liability insurance and Facility Emergency and Disaster Plan.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

LIC809 (FAS) - (06/04)

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