197610196-11-16-2021-31-AS-NRED-C8TVTA-20211116154250

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610196
Report Date: 11/16/2021
Date Signed: 11/16/2021 03:43:31 PM

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:	SOLVITA RESIDENTIAL CARE		FACILITY NUMBER:	197610196
ADMINISTRATOR:	GRIGORYAN, ARSEN		FACILITY TYPE:	740
ADDRESS:	7939 APPERSON ST		TELEPHONE:	(818) 518-3043
CITY:	SUNLAND	STATE: CA	ZIP CODE:	91040
CAPACITY:	6	CENSUS:	DATE:	11/16/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:59 AM
MET WITH:	Arsen Grigoryan		TIME COMPLETED:	03:45 PM

NARRATIVE

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Licensing Program Analyst (LPA) Nicholas Reed arrived to Solvita Residential Care (#197610196) at 11:59AM on 11/16/2021 and met with Administrator for an announced prelicensing inspection.

LPA toured the physical plant inside and out with Administrator.

LPA observed several postings upon entry, including an Administrator’s Certificate, Resident Rights, Confidential Complaint Hotline, Emergency and Disaster Plan, and Evacuation Procedures.

LPA observed audio alarms on four out of four exit doors.

LPA and Administrator tested Carbon Monoxide and Fire Detectors. 5 out of 5 detectors beeped and an automated voice alerted of an emergency. Two fire doors located at Bedroom #5 and the main hallway closed upon testing. LPA saw a fully charged fire extinguisher in dining room.

Kitchen: LPA noted adequate food preparation space in the kitchen, which was safe and clean. All equipment appeared in good repair. LPA observed a trash can with a tight-fitting lid. LPA measured the kitchen sink water temperature at 116.2 degrees Fahrenheit. LPA measured the refrigerator and freezer temperatures at forty (40) degrees and zero (0) degrees Fahrenheit, respectively. Administrator showed LPA sufficient perishable and non-perishable food supplies, as well as surplus water, for beyond 7 days. All sharp objects, toxins, and hazardous items were locked.

Bedrooms: LPA observed a chair, night stand, a lamp, and a chest of drawers in 5 out of 5 bedrooms. LPA also observed sufficient clean blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths for 6 residents. Facility also provided closet space, flashlights, and hygiene supplies in each room.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SOLVITA RESIDENTIAL CARE	FACILITY NUMBER: 197610196
	VISIT DATE: 11/16/2021

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Bathrooms: LPA observed grab bars in showers and around toilets, along with non-skid mats in 3 out of 3 showers. All bathrooms also had fully stocked soap, paper towels, toilet paper, and trash cans with tight-fitting lids.

Laundry: LPA observed two washers and two dryers outside of kitchen, both in good repair. Detergents and hazardous chemicals were locked up. The space used for laundry was not used for storage, and steam, odors, lint and objectionable laundry noise posed no issue.

Outside: LPA noted two exit gates. One led from Bedroom #4 and the other was close to the kitchen. Both were latched closed, unlocked, and opened by pushing a button. Walkways, ramps, and handrails were clean, secure, and free from obstructions.

LPA observed a medication lockbox in a separate storage area. Walls, wallpaper, paint, and ceiling were in good condition. Windows and blinds were in operating condition with clean screens. LPA observed clean floors. LPA saw nightlights in all hallways. All rooms were odorless and maintained at approximately 75 degrees Fahrenheit. LPA observed zero signs of flies or vermin at the facility.

At 1:35 PM, LPA and Administrator reviewed the facility’s Plan of Operation, Admission Agreement, Facility Sketch, Weekly Meal Menu, Activities Schedule, and COVID-19 Mitigation Plan. Administrator will acquire adequate PPE, COVID signage, and screening equipment prior to admitting residents.

At 2:15 PM, LPA and Administrator reviewed and completed Component 3.

LPA conducted exit interview and emailed Administrator the final report.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

LIC809 (FAS) - (06/04)

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