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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609992
Report Date: 06/24/2022
Date Signed: 06/27/2022 06:18:08 PM

Document Has Been Signed on 06/27/2022 06:18 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:GEVART A.R.F. INCFACILITY NUMBER:
197609992
ADMINISTRATOR:GHAZARYAN, YERANUHIFACILITY TYPE:
735
ADDRESS:8651 ROSLYNDALE AVETELEPHONE:
(323) 219-5454
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY: 4CENSUS: 4DATE:
06/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH: YERANUHI GHAZARYAN, TIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Tihesha “Lynn” Smith conducted an unannounced One (1) Year Required Infection Control visit to this facility at 9:20 am. LPA was greeted by staff: Glorie Yakamavua. LPAs temperature taken upon. LPA explained the reason for the visit. Administrator Yeranuhi Ghazaryan was called and arrive at 10:07 am.
LPA conducted a tour of the physical plant at 10:45 am to ensure there are no health and safety hazards and facility staff are following Title 22 Regulations and the following was noted:

The facility had a Mitigation plan and copy sent to LPA Smith by email.
Covid signs on front door, hand washing, coughing etiquette, physical distancing, and other necessary signs were posted in the bathrooms and all over the facility.

Facility has five (5) bedrooms: four (4) bedrooms for clients and one (1) bedroom designated as staff room. There are two (2) bathrooms: both located in hallway near bedroom #4. There is no body water in the facility.Bedrooms were toured and observed to be clean and properly furnished. Linen storage: clients have extra linen in their closets.
Bathrooms were observed to be clean and sanitary with necessary supplies. Hot water temperature at 115.1 and 115.2 degrees Fahrenheit.
Physical plant was checked for cleanliness and condition. Facility was in good repair and observed to be clean and free of clutter during today's visit.
Living and dining room furniture were also checked for functionality (wear and tear). Furniture was observed to
be in good condition and adequate seating for clients.
Kitchen area was observed to be clean and sanitary. All the toxins are locked in cabinet under kitchen sink. Sharps are locked in cabinet above stove. Laundry area accessible through kitchen observed to be clean and appliances in good repair. Laundry detergents and cleaners locked in cabinet above dryer.
(Cont. to 809C)
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2022
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: GEVART A.R.F. INC
FACILITY NUMBER: 197609992
VISIT DATE: 06/24/2022
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(Cont. from 809)

Food The facility is observed to have sufficient food supply for the clients both perishable and non-perishable.
Medications are located in locked a file cabinet in the locked entry closet. Two stocked first aid kits are also locked in entry closet. Medication was observed to be inaccessible to clients. Temperature of facility on wall thermostat is observed and set to 73 degrees Fahrenheit. Fire extinguisher is located in kitchen and observed to be charged. Dual Smoke alarms and carbon monoxide are hardwired and interconnected, were tested and observed to be operable. Garage is converted to office space, excess food storage and PPE storage area.
There are is a covered patio area in backyard with adequate seating.

The grounds entry/exits area were clean with and free of obstruction.


No Deficiencies cited. Exit interview conducted and printed.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
LIC809 (FAS) - (06/04)
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