<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609895
Report Date: 10/02/2024
Date Signed: 10/02/2024 04:03:41 PM


Document Has Been Signed on 10/02/2024 04:03 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:SUN VALLEY CARE COTTAGE LLCFACILITY NUMBER:
197609895
ADMINISTRATOR:BAGHDASSARIAN, FLORIDAFACILITY TYPE:
740
ADDRESS:8553 GLENCREST DRIVETELEPHONE:
(818) 785-2344
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY:6CENSUS: 0DATE:
10/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Administrator, Florida BaghdassarianTIME COMPLETED:
01:45 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), Leizl de la Cerra, conducted an unannounced annual inspection at the facility mentioned above. At 10:45am LPA was greeted by the Administrator and LPA explained the reason for the visit. Administrator granted LPA access to the facility.. The facility currently has no residents,

Facility is licensed to serve six (6) non-ambulatory residents, one (1) may be bedridden in room #3. The facility also has an approved hospice waiver for two (2) residents. The Annual Licensing Fees are current.

With the assistance of the administrator, LPA conducted a physical plant inspection at 11:00am and following was observed.


Bedrooms: The facility has a total of three (3) bedrooms. Three (3) bedrooms are designated for the residents. LPA observed all bedrooms are properly furnished and clean, All rooms have sufficient lighting.

Bathrooms: LPA observed two (2) bathrooms. Appeared to be clean and in good repair. Well stocked with toilet papers, soap and paper towels. LPA observed the appropriate grab bar and non-skid mat. The hot water temperature measured at 112.6°F.



Common Areas: The facility maintains a comfortable temperature at 76°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards observed. There is a fire extinguisher by the dining area observed to be operational.

CONTINUE to LIC809C

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Leizl De La CerraTELEPHONE: (818) 454-0632
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUN VALLEY CARE COTTAGE LLC
FACILITY NUMBER: 197609895
VISIT DATE: 10/02/2024
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
26
27
28
29
30
31
32
Kitchen: The kitchen appliances were functional. Knives were stored in a locked drawer in the kitchen. Food preparation areas are clean. Garbage cans have tight fitting covers. Kitchen cleaning supplies were stored in a locked cabinet.

Laundry Area: This is located in the bedroom hallway. There is a functioning washer and dryer. LPA observed laundry detergents and cleaning solutions were stored in locked cabinets.

Outside areas: At approximately, 11:40am LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area. LPA observed a pool at the back surrounded by a black 5 ft tall fence inaccessible to residents. LPA observed the fence was locked and inaccessible to residents in care. LPA observed a garage converted into a staff quarter in the back area.


Staff quarter observed to be locked and secured. Passageways and ramps around the home were clear of hazards.
Smoke detectors/carbon monoxide. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. At 12:15PM they were tested and deemed operational.

One (1) staff record was reviewed, Administrator Baghdassarian record had the current 1st Aid/CPR training. Administrator certificate is valid and will expire on 11/08/2024.

Postings: Ombudsman contact, personal rights, house rules, emergency disaster plan, activity schedule, and weekly menu were posted in the hallway.


The facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed during today’s visit. Exit interview conducted. Copy of report provided.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Leizl De La CerraTELEPHONE: (818) 454-0632
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2