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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610098
Report Date: 03/14/2022
Date Signed: 03/14/2022 10:52:10 AM


Document Has Been Signed on 03/14/2022 10:52 AM - 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:AFFORDABLE BOARD AND CARE INC.FACILITY NUMBER:
197610098
ADMINISTRATOR:KESHISHI, VILBERTFACILITY TYPE:
740
ADDRESS:11382 KAMLOOPS STTELEPHONE:
(818) 397-5690
CITY:LAKEVIEW TERRACESTATE: CAZIP CODE:
91342
CAPACITY:6CENSUS: 4DATE:
03/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Vartanosh Baghdasarian & Vilbert KeshishiTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility to conduct an unannounced infection control inspection/visit. LPA was greeted by caregiver Vartanosh Baghdasarian who allowed LPA to enter the facility. Administrator Vilbert Keshishi was contacted and arrived shortly after. LPA informed them the reason of the visit. The current census is (4), and (2) staff and (3) residents have been vaccinated; only (1) resident has received the booster. LPA observed hand sanitizing station, and visitor sign in book at the front door. LPA observed Licensing COVID-19 signs throughout the facility.

The infection control inspection was conducted with the Administrator. The facility has (4) bedrooms; with (3) shared room and beds were kept (6) feet apart. All common areas were observed to be clean, including bathrooms, that had soap and towels. There were hand washing signs observed at the kitchen sink and all bathrooms. LPA conducted a mitigation plan review with the Administrator, to obtain information on how the facility has implemented the plan. Administrator reported they continue weekly COVID testing. Daily temperature for residents is performed daily. Visitation is conducted outside on the backyard patio. Residents eat together and practice social distancing at the dining room table. Administrator informed LPA, he received the PINs from the department, and conducts training to staff in relation to COVID-19. There are designated rooms for potential positive COVID residents. PPE, chemicals, cleaning supplies, and paper products were observed.

LPA had a discussion with the Administrator, who stated, he has back-up staff if needed. Administrator informed LPA that they continue to implement the best practices for their facility. The facility is aware to report any changes with residents and staff to Licensing and there LPA, pertaining to positive COVID-19 cases.

Exit interview and copy of report provided.

SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022
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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