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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610196
Report Date: 11/29/2022
Date Signed: 11/29/2022 02:40:19 PM


Document Has Been Signed on 11/29/2022 02:40 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:SOLVITA RESIDENTIAL CAREFACILITY NUMBER:
197610196
ADMINISTRATOR:GRIGORYAN, ARSENFACILITY TYPE:
740
ADDRESS:7939 APPERSON STTELEPHONE:
(818) 518-3043
CITY:SUNLANDSTATE: CAZIP CODE:
91040
CAPACITY:6CENSUS: 6DATE:
11/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Angela Garcia & Helen UguryanTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility to conduct an unannounced infection control visit. Upon arriving, LPA was greeted by caregiver Angela Garcia, who allowed LPA to enter the facility; she was informed the reason of the visit. LPA was informed Administrator was not available, due to personal reasons, and his assistant Helen Urguryan was contacted and arrived at the facility shortly after. There have not been any active or past COVID cases at the facility since the beginning of the pandemic. Staff and residents have been vaccinated, and (4) residents have received boosters and staff have received them. The current census is (6). LPA temperature was taken, and LPA observed the visitors sign in sheet and cleaning table, with hand sanitizer at the front door. LPA observed staff to have full mask covering.

The physical plant infection control inspection began with the caregiver Angela. The facility has (5) bedrooms; with (2) private rooms, and (2) shared; with (1) room used for staff office. The staff office will convert into a isolation room if needed for positive COVID cases. All bedrooms were properly furnished, and beds were (6) feet apart. The common areas were observed to be clean, including bathrooms, with soap and towels. LPA was made aware, from the assistant Helen, she was not sure if an infection control plan was submitted. LPA will forward a copy to her, so that it can be submitted, due 12/06/2022 by 5pm.

LPA was informed, the facility has documentation of all vaccination records. COVID testing is conducted as needed, when staff or resident display any symptoms. Everyone that leaves the facility, is screened once they return with temperature check. All new employee hires are encouraged to be vaccinated; it's not a mandate but must have a negative COVID test prior to entering the facility.

SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022
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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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: 11/29/2022
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The assistant reported to LPA, the Administrator receives the departmental emails. There is currently no paid sick leave policy in place, but in the future they plan to implement. The facility does not have staffing issues at this time, but LPA discussed there needs to be a back-up plan in place for emergencies. PPE, chemical, and paper products are kept locked inside a cabinet.

LPA informed assistant, that they continue to implement the best practices for their facility, which has kept them COVID-19 free, and to report any changes with residents and staff to Licensing and there LPA.

Exit interview conducted 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: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC809 (FAS) - (06/04)
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