197609909-1-30-2024-31-AS-APAA-CZYRHB-20240130120203

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609909
Report Date: 01/30/2024
Date Signed: 01/30/2024 12:02:38 PM

Document Has Been Signed on 01/30/2024 12:02 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:	SKY LIGHT RESIDENTIAL CARE		FACILITY NUMBER:	197609909
ADMINISTRATOR:	PODRUMYAN, MARO		FACILITY TYPE:	740
ADDRESS:	19856 MAYALL STREET		TELEPHONE:	(818) 945-8301
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	6	CENSUS: 5	DATE:	01/30/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Maro Podrumyan, Administrator		TIME COMPLETED:	12:30 PM

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At 10:00am Licensing Program Analysts (LPAs) Angela Panushkina and Perchui Milena Khurshudyan conducted an unannounced annual inspection at the facility mentioned above. LPAs were greeted by staff, Nelli Tovmasyan, who granted access to the facility. At approximately, 10:05am physical tour was conducted with the staff and LPAs observed the following:

Kitchen: At approximately, 10:10am LPAs toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents.

Medications: At approximately, 10:20am LPAs observed medications are centrally stored and locked in the cabinet, by the kitchen area and inaccessible to residents in care.

Bedrooms: There are five (5) bedrooms designated for residents use and one (1) staff room. All rooms were observed to have sufficient lighting, and are properly furnished, clean and have appropriate bedding and linens. Auditory alarms were tested and observed to be operational.

Bathrooms: At 10:30am LPAs observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 120.00°F. LPAs observed appropriate grab bar and had non-skid mat. LPAs observed appropriate hand washing signs posted in each bathroom. All trash cans in bathrooms had fitted lids to protect from cross contamination.

Common Areas: The facility maintains a comfortable temperature at 68°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility.
Continue on LIC809-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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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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: SKY LIGHT RESIDENTIAL CARE	FACILITY NUMBER: 197609909
	VISIT DATE: 01/30/2024

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The laundry room is located by the staff room in the kitchen area. The washer/dryer appear to be in good condition. LPAs observed all detergents locked and inaccessible to residents in care. There is a fire extinguisher in the kitchen area and in a hallway were last purchased on 02/06/2023.

Outside areas: At approximately, 10:50am LPAs toured the outside area of the facility. LPAs observed appropriate outdoor furniture, with a covered shaded area for clients. There is a swimming pool that is fenced all around with a gate that will be kept locked at all times. The fence surrounding the swimming pool is approximately 5 feet high all around. You will need a key to gain entry to the swimming pool. LPAs discussed the importance of maintaining the care and supervision to meet the needs of residents.

Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and observed to be operational.

Between 11:00am to 12:00pm, LPAs reviewed records of five (5) clients and two (2) staff. Client and staff records appeared to be complete and updated.

Administrative: LPAs collected Certificate of Liability Insurance, Administrator Certificate and LIC.500.

No citations issued during this visit. Exit interview conducted. Copy of report emailed to Licensee.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC809 (FAS) - (06/04)

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