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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609876
Report Date: 01/13/2024
Date Signed: 01/13/2024 01:49:30 PM


Document Has Been Signed on 01/13/2024 01:49 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:A-1 ASCENDED SENIOR CAREFACILITY NUMBER:
197609876
ADMINISTRATOR:TOPCHYAN, HARUTFACILITY TYPE:
740
ADDRESS:16444 GERMAIN STREETTELEPHONE:
(818) 667-4915
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 5DATE:
01/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:44 AM
MET WITH:Tamar KhatchadourianTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Tamar Khatchadourian, and explained the reason for the visit. The administrator, Harut Tophyan was unable to attend today's annual visit, but was available over the telephone.

At approximately 10:50am, 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. It is hardwired and interconnected. The fire extinguisher is fully charged. It is located in the kitchen.

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 were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets.

Bedrooms: There were five (5) bedrooms designated for residents' use. Four bedrooms are private, and one bedroom is shared. All bedrooms were properly furnished with appropriate beddings and linens with sufficient lighting. Exit doors in resident rooms were checked to insure door alert was working.

Bathrooms: There are two (2) bathrooms. LPA observed that the bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 105 degrees Fahrenheit. LPA did not observe any cleaning supplies in either bathrooms accessible to the residents during the day's inspection.

Common Areas: These included the living room and dining area. The common areas were properly furnished. The floors were cleaned. The furniture is maintained. The dining room table is large enough to seat at least six (6) residents at a time. The auditory alarms on all exit doors were on and functional at the time of the visit. Hallway and passageway is clear of obstruction.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: A-1 ASCENDED SENIOR CARE
FACILITY NUMBER: 197609876
VISIT DATE: 01/13/2024
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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 backyard is large enough to hold outdoor activities. Laundry area is located in the garage. Laundry detergents, cleaning supplies and other toxins will also be stored in a locked cabinet in the garage.

Staff Workstation: Staff workstation is located by the kitchen. It is off limits to the residents.

Resident Files: LPA conducted a file review of resident records.

Staff Files: LPA also conducted a file review of staff records.

Medications: Medication and Medication Records were review for proper storage documentation. Medications were observed to be stored in a designated secured cabinet

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 MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2