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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610102
Report Date: 11/20/2020
Date Signed: 11/20/2020 11:16:13 AM

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:ALLEVIATE CAREFACILITY NUMBER:
197610102
ADMINISTRATOR:ESTRADA, LOURDES M.FACILITY TYPE:
740
ADDRESS:20930 GAULT STREETTELEPHONE:
(818) 378-2772
CITY:CANOGA PARKSTATE: CAZIP CODE:
91303
CAPACITY:6CENSUS: 5DATE:
11/20/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Edgar GhazaryanTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Wendell Smith conducted a virtual prelicensing visit through face-time with applicant representative Edgar Ghazaryan.
LPA was given a tour of the physical plant. Facility currently has five residents residing in it. The property is a single dwelling home; five (5) bedrooms and three (3) bathrooms. LPA toured facility with applicant - four (4) bedrooms are for consumers/residents. Three (3) bedrooms are non-ambulatory and one (1) bedroom is for ambulatory only. Bedrooms have required furnishings and equipment; one (1) bedroom is designated for staff. There are three bathrooms two (2) bathrooms are residents, and one (1) bathroom designated for staff/guests. LPA observed residents to be watching television in their bedrooms. There is a family room, separate kitchen and dining are, an activity/living room. Family and activity/living rooms observed with couches, and games/activity supplies for consumers use. Dining area observed set up with table and chairs (for six consumers). Kitchen area inspected: Knives and cleaning supplies are stored in locked drawers. LPA observed there to be a sufficient amount of perishable and non perishable food. Janitorial supplies and other toxins will be stored in locked cabinets and/or garage area. . Laundry area viewed outside near garage with lock. Garage is detached from the home and is made inaccessible. No bodies of water observed.
Supply of personal toiletries, cleaning supplies and an adequate amount of towels and bedding supplies observed.
Smoke alarms/carbon monoxide detector observed installed in home. Smoke alarms tested and observed to be operable. Fire extinguisher also observed in the kitchen area.

Outdoor areas observed clean and hazardous free; Patio area observed shaded with patio furniture for clients use. Outside side gate observed with spring/self closing.
Only thing that is needed is for applicant to complete the component three which will be done on 11/23/2020.
Exit Interview completed. Copy of report emailed. Hard copy signature on file.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell SmithTELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2020
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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