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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610214
Report Date: 10/29/2021
Date Signed: 10/29/2021 10:22:16 AM

Document Has Been Signed on 10/29/2021 10:22 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:DE GARMO HOMEFACILITY NUMBER:
197610214
ADMINISTRATOR:PETROSYAN, MARIETAFACILITY TYPE:
735
ADDRESS:8356 DE GARMO AVETELEPHONE:
(818) 424-9953
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 4CENSUS: 0DATE:
10/29/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marieta PetrosyanTIME COMPLETED:
10:30 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
Licensing Program Analyst (LPA) Tuesday Cabiness conducted a PRE-LICENSING visit to the above address 8326 De Garmo, Sunland, CA 91352. LPA met with Administrator/Licensee Marieta Petrosyan. Upon entry, LPA was COVID screened with temperature check and visitor record book. The inspection included, fire safety, personal accommodations, building and grounds, furniture/equipment, and food service. Fire inspection was approved on July 22, 2021. Facility sketch, emergency disaster plan, complaint procedures, visiting policy, house rules, personal rights, emergency exit plan, and COVID, CDC, and Department of Public Health signs were visually posted throughout the facility.

The physical plant was toured inside and out with Administrator Marieta. The facility is a one level home, with (4) bedrooms; with (1) room for staff, (2) private, and (1) shared, which the staff room will be used for isolation room if needed for positive COVID cases. Facility has (3) bathrooms. Food supply was inspected and observed, and storage areas, cabinets, pantries, cupboards counters, and refrigerator were clean and appropriate for food preparation. Knives and medication will be stored in cabinets located in the kitchen and hallway. Appliances were clean and functional, and utensils, plates, and cups were in good repair. Cleaning supplies, poisons, toxins and chemicals are locked and stored in the garage. There was enough supply of linens and towels, which were stored individually in the client bedrooms. Hygiene products were also available. PPE supplies were inspected.

The common areas included the dining, living, bathroom, and client bedrooms. Doors and passageways were clear and unobstructed. Walls, ceilings, floors, window screens and all other rooms were clean, in good repair, and appropriately furnished. Client rooms observed to have a mattress with pad, sheets, pillow, bedspread, dresser, closet space, and chair.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2021
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: DE GARMO HOME
FACILITY NUMBER: 197610214
VISIT DATE: 10/29/2021
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
Bathrooms were clean had functional fixtures, with soap and towels and hand washing signs. The water temperature measured at 118.4 degrees Fahrenheit. The back yard is completely fenced with a (2) gates easily accessible and unlocked. There was no swimming pools or other bodies of water. There is a storage shed that was locked, and used for extra supplies. No other visible hazards around the surrounding grounds.

Smoke detectors and carbon monoxide were operating correctly. Fire extinguisher is fully charged. Telephone system was working. First aid kit inspected. Garage area was locked and secured. Staff and client files will be stored in a locked closet. Administrator is waiting to be vendorized with Regional Center for admits. Mitigation plan will be emailed to LPA. Facility is ready for to licensed.

Exit interview, COMP III conducted/completed, and report issued to Administrator.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2