197609876-3-5-2025-31-AS-MCAA-DEGQGQ-20250305110956

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609876
Report Date: 03/05/2025
Date Signed: 03/05/2025 11:10:06 AM

Document Has Been Signed on 03/05/2025 11:10 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	A-1 ASCENDED SENIOR CARE		FACILITY NUMBER:	197609876
ADMINISTRATOR/ DIRECTOR:	TOPCHYAN, HARUT		FACILITY TYPE:	740
ADDRESS:	16444 GERMAIN STREET		TELEPHONE:	(818) 667-4915
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS:	DATE:	03/05/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:37 AM
MET WITH:	Tamar Khatchadourian, Alva Ramos		TIME VISIT/ INSPECTION COMPLETED:	11:15 AM

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 staff, Tamar Khatchadourian and Alva Ramos. They were advised of for the reason of the visit. The administrator, Harut Tophyan was advised of the annual over the telephone. At approximately 8:45am, with the assistance of staff, LPA took a tour of the physical plant. The facility is a one story building. Required postings were observed in the entry area. The smoke alarms and carbon monoxide are dual and interconnected. The fire extinguisher is located in the kitchen. Charge date is 01/09/25. Complete 1st aid kit is maintained in the kitchen, by the fire extinguisher. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food properly stored. Knives were stored in a locked drawer in the kitchen. Bedrooms: There were five (5) bedrooms designated for residents' use. Rooms #1 to #4 are private, and Room #5 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 107 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 living room is furnished with two couches, one recliner, a chair and television. There is a fireplace that is non-functional. Fireplace has a chained screen and glass door. The dining room table is large enough to seat up to six (6) individuals. The auditory alarms on all exit doors were on and functional at the time of the visit. Floors in common areas were mopped and clean, and the furniture was in good repair. Hallway and passageway were clear of obstruction.

Eva Miller	TELEPHONE: (818) 596-4373
Michael Cava	TELEPHONE: (818) 389-7921
	DATE: 03/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025

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: A-1 ASCENDED SENIOR CARE	FACILITY NUMBER: 197609876
	VISIT DATE: 03/05/2025

NARRATIVE

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Surrounding Grounds: Entry/exits were free of obstruction. The backyard is large enough to hold outdoor activities. No immediate health and safety hazard observed during the day of the inspection.

Garage: The garage is attached to the home. It remains locked and inaccessible to residents. LPA observed another refrigerator in the garage, that stores additional perishable food items. Garage is also used as storage for supplies.

Laundry: 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. Staff and resident records maintained were maintained there. Staff workstation 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: Medications are kept locked in a kitchen cabinet. Medication and Medication Records were reviewed for proper storage and 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: 03/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025

LIC809 (FAS) - (06/04)

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