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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610054
Report Date: 08/30/2022
Date Signed: 08/30/2022 12:27:05 PM


Document Has Been Signed on 08/30/2022 12:27 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: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: 0DATE:
08/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Leo SayadyanTIME COMPLETED:
12:41 PM
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At 11:50 a.m. on 08/30/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit. LPA met with Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out.

The facility was last visited on 07/14/2021 for an annual visit. It is a single story building with 3 bedrooms, 2 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 residents, of which 1 may be bedridden in Bedroom #1. Approved hospice waivers for six.

Due to staffing needs, the facility has not yet admitted any residents.

A screening station near the front entrance contained digital thermometer and visitor log. The visitor log tracked temperature, symptoms, and vaccination status. The 3 shared bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. The emergency exit in Bedroom #1 was free of obstructions. The facility has 2 bathrooms. The resident bathroom contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. Kitchen appliances were functional and sanitary. Sharps and cleaning solutions were locked. A washer and dryer were in good condition. Detergent was locked above the appliances. Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. All emergency exit paths were free from obstructions. Exit gates were unlocked with inward facing latches. At 12:10 p.m. LPA tested the dual functioning smoke and carbon monoxide detector to be operational. At 12:19 p.m. LPA observed a fully charged fire extinguisher in the dining room. A covered patio contained furniture in good condition.

During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued.

Exit interview conducted. Copy of report issued.

SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2022
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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