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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609987
Report Date: 11/04/2024
Date Signed: 11/04/2024 01:20:29 PM

Document Has Been Signed on 11/04/2024 01:20 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:FAIRWEATHER SENIOR FACILITYFACILITY NUMBER:
197609987
ADMINISTRATOR/
DIRECTOR:		MINASYAN, MAGDAFACILITY TYPE:
740
ADDRESS:19343 FAIRWEATHER ST.TELEPHONE:
(818) 917-1097
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
11/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Magda MinasyanTIME VISIT/
INSPECTION COMPLETED:
01:15 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) Tuesday Cabiness was greeted by Administrator Magda Minasyan, who was informed the reason of the visit, which was to conduct the annual required inspection. The current census was (6) during the visit. LPA observed residents in there rooms and resting in the living room. The facility is fire cleared for six (06) non-ambulatory and has a hospice waiver for six (06).

A physical plant inspection was conducted with the Administrator. LPA observed one entrance being utilized at the facility, there are required posters at the main door. Screening area is located immediately upon entrance. Sign in sheet, infrared thermometer, hand sanitizer, gloves and masks are available. Hand washing, coughing etiquette, physical distancing and other necessary signs are posted at the front door, and throughout the facility.

Common areas: The living and dining room was clean and appropriately furnished. Inside temperature was comfortable, and passageways were free from obstruction. Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. There are (2) refrigerators stocked with food and (1) in the garage. Knives and sharps are observed to be locked and inaccessible to residents. Bedrooms: The facility has a total of (6) bedrooms and three (03) bathrooms; (2) shared rooms and (2) private. Rooms were appropriately furnished, and were neat and clean. Bathrooms: There are (3), and were checked for cleanliness and proper operations. There are grab bars located in the shower and by the toilet. The hot water temperature was measured at 105.8°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication and first aid kit to be locked and inaccessible to residents.
Troy AgardTELEPHONE: (818) -596-4334
Tuesday CabinessTELEPHONE: (818) 299-4975
DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: FAIRWEATHER SENIOR FACILITY
FACILITY NUMBER: 197609987
VISIT DATE: 11/04/2024
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
The facility does not have a swimming pool/body of water. The garage is currently being used for storage. Laundry detergents, cleaning agents and other toxins are locked away. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguishers are located near the kitchen area and living area, observed to be full charged. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. Backyard had (2) exit gates that were easily accessible to open. There is a covered area with patio furniture for residents and visitors.

Record review: LPA checked records for staff and residents; all required Licensing documents located in files.

No health and safety hazards noted during the visit.



Exit interview conducted. Copy of this report issued.
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2