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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610214
Report Date: 11/15/2022
Date Signed: 11/15/2022 01:52:01 PM

Document Has Been Signed on 11/15/2022 01:52 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:DE GARMO HOMEFACILITY NUMBER:
197610214
ADMINISTRATOR:ASATROYAN, LUSINEFACILITY TYPE:
735
ADDRESS:8356 DE GARMO AVETELEPHONE:
(747) 223-2843
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 4CENSUS: 0DATE:
11/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Marieta PetrosyanTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator Marieta Petrosyan to conduct an annual inspection. The facility currently has no clients, and Administrator is waiting to be vendorized with Regional Center. Upon entry, LPA observed COVID signs posted on the front door and throughout the walls of the facility. LPA's temperature was taken.

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 facility has (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. 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. PPE supplies were inspected.

Administrator reported to LPA, new admits who are not vaccinated will be COVID tested. All new employee hires and properly screened, and provided a negative COVID test and must be vaccinated prior to entering the facility and employment. The facility does have rapid COVID test available. Administrator reported to LPA, she receives departmental emails. The common areas dining, living, bathroom, and client bedrooms, were clean and in good repair. Facility is ready to admit clients.

Exit interview and copy of report provided.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
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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