<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610192
Report Date: 09/03/2021
Date Signed: 09/03/2021 11:03:08 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:BEST YEARS ASSISTED LIVING, INCFACILITY NUMBER:
197610192
ADMINISTRATOR:BALIAN, HOVANNES SHANTFACILITY TYPE:
740
ADDRESS:7630 WILBUR AVE.TELEPHONE:
(818) 388-2442
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 3DATE:
09/03/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Administrator, Hovannes Shant BalianTIME COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At 9:05am Licensing Program Analysts (LPAs), Angela Panushkina, Joscelyn Martinez and Licensing Program Manager (LPM), Nichelle Gylliard conducted an announced Pre-Licensing visit to the above facility and met with applicant Hovannes Shant Balian. This is a change of ownership application from (Facility #197609734) to (Facility #197610192). LPA team conducted an entrance interview with the Administrator. At the time of this visit LPAs observed and assessed three (3) residents present in the facility. All residents appear to be clean and groomed. Fire Clearance dated 05/20/2021 was received for six (6) bedridden residents. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. The facility is a single-story building. Today's site visit consisted of LPAs touring the physical plant inside and outside and observed the following:

The facility has a total of five (5) bedrooms, five (5) of which are designated for resident use. Resident bedrooms were observed to be appropriately furnished. There are two (2) bathrooms in the facility designated for resident use and were observed to have non-skid mats and appropriate grab bars installed. The facility will have awake staff at night and one (1) bathroom is designated for staff use only.

The common areas (living room, kitchen and dining areas) were appropriately furnished and lighting was adequate. The living room has a television and comfortable furniture. Resident and staff records will be stored in a locked cabinet near the entrance area. The fire extinguisher is located in the kitchen and was observed to be fully charged and was last serviced on 06/17/21. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 10:20am they were tested and observed to be operational. At 9:22am the hot water was tested and measured between 115.5 - 118.4 Fahrenheit. There is a functioning telephone on the premises. An emergency exit plan/sketch is posted by the entrance wall with other posting requirements. Medications are stored in a locked cabinet in the living room area. The first aid kit is readily available. Continue on LIC809-C

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: BEST YEARS ASSISTED LIVING, INC
FACILITY NUMBER: 197610192
VISIT DATE: 09/03/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Facility appears to be clean, in good repair and kept at a comfortable temperature of 75°F. Appliances in the kitchen appeared to be functional. LPA team observed enough sufficient supply of 2 days perishable foods and one week of non-perishable foods on premises. The necessary precautions have been made to the facility to safely house dementia residents such as auditory alarms on all doors. Plan of operation for dementia residents was also discussed with the Administrator.

There is a shaded sitting area in the backyard for residents to conduct outdoor activities. The backyard is fenced. There is an empty lot in a back yard that will be separated with a different address in a future. The attached garage is kept locked. The garage is currently being used for perishable and non-perishable food storage and PPE storage. At approximately, 9:49am LPA team toured through the laundry area and observed all chemicals and cleaning supplies area locked and inaccessible to residents in care.

Component III was conducted with the administrator.

Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and be notified by the CAB Analyst when your license has been approved.

Exit interview was conducted with Administrator Hovannes Shant Balian and a copy of this report was provided.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2