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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610054
Report Date: 08/04/2023
Date Signed: 08/04/2023 12:06:01 PM


Document Has Been Signed on 08/04/2023 12:06 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:LEO'S ASSISTED LIVING IIFACILITY NUMBER:
197610054
ADMINISTRATOR:ARAKELIAN, ARMINEFACILITY TYPE:
740
ADDRESS:7567 BOVEY AVENUETELEPHONE:
(310) 292-2992
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 4DATE:
08/04/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:TIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Antonia Alvizar and Licensing Program Manager (LPM) Naira Margargan met with facility staff, Narine Arakelyan at 8:15AM and LPM and LPA was greeted by staff and granted entrance. The purpose of the visit was explained. On 07/28/2023 a Plan of Correction was conducted due to facility not submitting Liability Insurance as it was requested. During visit other Title 22 Deficiencies were noted and citations were issued. Plan of Corrections for the issued citation were not submitted by POC due date and this visit was conducted to determine if plan of corrections were satisfied.

At 8:28AM LPA requested a copy of the liability insurance. Staff was unable to locate the document, Khatchik Danielian (Administrator) was contacted and arrived at 9:15AM.
Once again, LPA Alvizar explained that the purpose of this visit is to clear deficiency issued 07-05-2023 and 07-28-2023. At 10:00 AM LPA and Staff conducted a tour of the facility.

At 10:45AM Khatchik provided appropriate documentation stating that Liability insurance was processed, and they are waiting for the final binder. The copy of Certificate of Liability Insurance will be received upon with the binder. At 11:00AM Khatchik provided appropriate documentation about Palliative Care, identifying the services they provided. The services included a wound care and staging of pressure injuries.
Based on information received during this visit, the plan of correction is satisfied. During today’s visit LPA and LPM received all appropriated documents to clear the plan of corrections.

In addition, during today’s visit LPA and LPM discussed Health and Safety Code regarding facility abandonment and other issues. The Administrator was informed that they may be called to the Woodland Hills South Licensing Office to Discuss the current facility status.

No citations were issued during this visit.
Exit interview was conducted and copy of report was issued.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia AlvizarTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2023
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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