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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609860
Report Date: 09/18/2024
Date Signed: 09/19/2024 09:48:02 AM


Document Has Been Signed on 09/19/2024 09:48 AM - 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:AMAZING SENIOR CARE, INCFACILITY NUMBER:
197609860
ADMINISTRATOR:ANNA PETROSYANFACILITY TYPE:
740
ADDRESS:16938 CITRONIA STREETTELEPHONE:
(818) 853-6695
CITY:NORTHRIDGESTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 5DATE:
09/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Yelena Aladadyan- AdministratorTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPA), Leslie Ngo-Castaneda conducted an unannounced Required 1-year inspection at this facility at approximately 12 NN LPA were greeted by staff, Shake Sargysyan and was explained the reason for the visit. at 12:10 PM the administrator arrived and was disclosed the purpose of the visit.

LPAs conducted a tour of the physical plant at approximately 12:04 PM to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

Common areas were observed for the ability to safely serve the needs residents. These included the kitchen, dining room area and living room. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be furnished appropriately.

LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The
kitchen food supply was observed and sufficient for the five (5) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meats and frozen vegetables. Sharps are stored in locked kitchen drawer. The resident medications are locked in office cabinets near the kitchen. The medications were observed to be inaccessible to residents. There is one (1) fire extinguishes located in the kitchen. Fire extinguishers observed to be charged at 11.1.2023.

Laundry room beside the kitchen and has an attached garage. The appliances observed to be functional.

Due to time constraints this required annual will be completed at a later time.

Exit interview conducted/Copy of report given
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-CastanedaTELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2024
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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