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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610196
Report Date: 12/17/2024
Date Signed: 12/18/2024 12:37:30 AM

Document Has Been Signed on 12/18/2024 12:37 AM - 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:SOLVITA RESIDENTIAL CAREFACILITY NUMBER:
197610196
ADMINISTRATOR/
DIRECTOR:		GRIGORYAN, ARSENFACILITY TYPE:
740
ADDRESS:7939 APPERSON STTELEPHONE:
(818) 518-3043
CITY:SUNLANDSTATE: CAZIP CODE:
91040
CAPACITY: 6CENSUS: 5DATE:
12/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Alita Gasparyan/Jemma Barseghyan, CaregiverTIME VISIT/
INSPECTION COMPLETED:
06:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Leizl de la Cerra met with Alita Gasparyan and Jemma Barseghyan (caregivers/ designee) for a required one year annual visit at 2:00PM. Caregivers attempted to make contact with administrator by telephone. The administrator informed LPA that they are unavailable for the annual visit.

A tour of the physical plant was conducted and the following was noted:


At 2:30PM LPA conducted a walk through of the facility with the caregiver.
LPA observed several postings upon entry, including an Administrator’s Certificate, Resident Rights, Confidential Complaint Hotline, Emergency and Disaster Plan, and Evacuation Procedures.


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 observed 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 all residents. Facility also provided closet space, flashlights, and hygiene supplies in each room.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
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: SOLVITA RESIDENTIAL CARE
FACILITY NUMBER: 197610196
VISIT DATE: 12/17/2024
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Bathrooms: LPA observed grab bars inside the showers and beside the 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. LPA measured the the water temperature at 116.2 degrees Fahrenheit.

Laundry: LPA observed two washers and two dryers outside of kitchen, both in good repair. Detergents and hazardous chemicals were locked up.

Outside: Walkways, ramps, and handrails were clean, secure, and free from obstructions. LPA observed an unlocked shed.

LPA observed sound alarms for the three (03) exit doors did not function, only for the front exit door.

LPA observed a locked medication cabinet in the bedroom hallway. LPA observed clean floors all throughout the facility. LPA saw night lights in all hallways. All rooms were odorless and maintained at approximately 73 degrees Fahrenheit. LPA observed no signs of flies or vermin at the facility.

Facility Records:LPA conducted review of residents’ records and staff records.


LPA reviewed three (3) out five (5) resident's records and three (3) staff records. The facility files were kept in locked cabinet in the dining area.

For the deficiency observed (refer to LIC809-D). Exit Interview Conducted. Copy of this report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/18/2024 12:37 AM - It Cannot Be Edited


Created By: Leizl De La Cerra On 12/17/2024 at 05:44 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SOLVITA RESIDENTIAL CARE
FACILITY NUMBER: 197610196

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in two [2] out of two [2] staff are missing records which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/03/2025
Plan of Correction
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Administrator will submit completed staff files for Alita Gasparyan and Jemma Barseghyan to LPA by POC due date,
Type B
Section Cited
CCR
87705(k)
Care of Persons with Dementia
(k) The following initial and continuing requirements must be met for the licensee to utilize delayed egress devices on exterior doors or perimeter fence gates:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above LPA obseved the delayed egress alarms for other exit doors had been turned off by administrator which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2024
Plan of Correction
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Licensee/Administrator will turn on the sound alarms for all exit doors and submit proof to CCL by POC date.
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:Naira Margaryan
LICENSING EVALUATOR NAME:Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2024


LIC809 (FAS) - (06/04)
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