197610192-9-26-2024-31-AS-HRAI-D9GSQ5-20240926140411

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610192
Report Date: 09/26/2024
Date Signed: 09/26/2024 02:05:25 PM

Document Has Been Signed on 09/26/2024 02:05 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	BEST YEARS ASSISTED LIVING, INC		FACILITY NUMBER:	197610192
ADMINISTRATOR:	BALIAN, HOVANNES SHANT		FACILITY TYPE:	740
ADDRESS:	7630 WILBUR AVE.		TELEPHONE:	(818) 732-7737
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 5	DATE:	09/26/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Stephen Parks, House Manager		TIME COMPLETED:	02:40 PM

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At 9:30 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual visit. LPA met with the House Manager, Stephen Parks and LPA disclosed the reason for the visit. LPA and the House Manager toured the facility inside and out.

It is a single story building with five (5) bedrooms, three (3) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for six (6) residents, of which six (6) may be bedridden. Approved hospice waivers for six (6). Additionally, LPA observed an ADU unit with the address of 7628 Wilbur Avenue, Reseda, CA 91335, built in the property. LPA was not provided an access to the property since it was locked. Administrator informed LPA that the unit is vacant and no individuals residing at the unit.

Kitchen: At approximately, 9:45 AM LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen drawer. LPA observed a fully charged fire extinguisher hung in the kitchen purchased on 08/30/2024. A laundry area near the kitchen contained an operable washer and dryer. Cleaning solutions were locked near the appliances.

Medications: At approximately, 9:50 AM LPA observed medications are centrally stored and locked in a moveable locked cabinet located in an office area near the main entrance. LPA did not observe a Centrally Stored Medication and Destruction Record (CSDMR/LIC 622) for five (5) out of five (5) residents. Review of R1’s medication revealed that the facility was supposed to start Ezetimibe 10 MG (High Cholesterol Medication) a new bottle on 08/15/2024. During today's visit LPA counted R1's medication and it was discovered that there was a discrepancy, and sixteen (16) extra pills were in the bottle. LPA asked the Administrator for explaining and the Administrator stated that they might have extra pills from an old bottle that was administered; however, due to the lack of documentation of Centrally Stored Medication Record (LIC 622), LPA could not verify the information with new bottle start date. A deficiency will be cited.

Continue on LIC809-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BEST YEARS ASSISTED LIVING, INC	FACILITY NUMBER: 197610192
	VISIT DATE: 09/26/2024

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Garage: LPA observed the garage locked and contained extra food, a second refrigerator, PPE, incontinence supplies, and assistive devices.

Bedrooms: The facility had five (5) bedrooms. Three (3) were private and two (2) were shared. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Facility has awake staff.

Bathrooms: LPA observed three (3) bathrooms and all bathrooms appeared to be clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and client's bathroom had non-skid mat. LPA observed appropriate hand washing signs posted in each bathroom. At 9:55 AM, hot water temperature measured at 113°F.

Common Areas: The facility maintains a comfortable temperature at 75°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility.

Smoke detectors/carbon monoxide. At 10:05 AM, LPA tested the dual-purpose smoke and carbon monoxide detector to be operational. All detectors were hard-wired, and the facility uses fire sprinklers. All auditory alarms were on, functioning, and centrally wired.

Outside areas: At approximately, 10:20 AM LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. The emergency exit path was unlocked and free from debris.

Between 11:15 AM to 12:45 PM, LPA reviewed records of five (5) residents and two (2) staff. Residents and staff records appeared to be complete and updated.

LPA determined that a Case Management visit regarding an ADU permit verification will be conducted on another day.

Administrative: LPA collected Certificate of Liability Insurance, and LIC500.

A deficiency cited during today’s visit. Appeal Rights explained.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 09/26/2024 02:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BEST YEARS ASSISTED LIVING, INC	FACILITY NUMBER: 197610192
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87465(c)(2)

87465- Incidental Medical and Dental Care: c) If the resident's physician has stated in writing... 2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on (observation) (interview) (record review)], the licensee did not comply with the section cited above in not assuring that R1's prescribed medications were given as prescribed, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 09/27/2024
	Plan of Correction
1 2 3 4	Administrator agreed to schedule vendorized training for all staff including the Administrator by 09/27/2024 and submit to CCL the vendor information and scheduled date of training. Training certifications to be submitted to CCL upon completion. Administrator also agreed to notify doctor and submit LIC 624 to CCL regarding the incident.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC809 (FAS) - (06/04)

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