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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610215
Report Date: 02/15/2022
Date Signed: 02/15/2022 01:03:15 PM


Document Has Been Signed on 02/15/2022 01:03 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:BAHAMA ASSISTED LIVING, INCFACILITY NUMBER:
197610215
ADMINISTRATOR:AVOYAN, MARIETAFACILITY TYPE:
740
ADDRESS:15851 BAHAMA STREETTELEPHONE:
(747) 236-7322
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 4DATE:
02/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Karine SarkisyanTIME COMPLETED:
01:05 PM
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Licensing Program Analyst (LPA) Yelena Avetisyan conducted an unannounced case management visit to this facility. Allegation of unlicensed care was substantiated at this locations on 9/3/2021 at which time A NOTICE OF OPERATION IN VIOLATION OF LAW was issued to the operator Karine Sarkisyan. (Complaint Control # 31-AS-20200821094334)

Upon arrival LPA met with staff Staff Hasmik/Jasmine Hokinyan. Applicant/operator Karine Sarkisyan arrived approximately 12:15 pm. At approximately 11:50 am LPA conducted a tour of the facility and confirmed that the home continues to provide care and supervision to 3 residents. Additionally LPA also observed that the home has sufficient food supply. All residents appeared clean and in good spirits waiting for lunch. Per caregiver there have not been any unusual incidents with the residents since the Departments last visit which was conducted on 01/19/2022. During todays visit Ms. Sarkisyan informed the LPA that Resident 1 (R1) moved out from the facility on 2/12/2022.


An application for RCFE license for this location; "Bahama Assisted Living Inc" was submitted by the operator and is currently pending. LPA reminded the staff that no new residents shall be admitted at this time (pending status). LPA also reminded the staff that a Notice of Operation in Violation of Law was served to the operator during the complaint investigation and that continued operation pending process of application is a violation of law, subject to civil penalties under Health and Safety Code Section 1547, 1568.0821, 1569.485, or 1596.893 b, and applicable regulations, as well as other actions by the Department. Exit interview conducted and copy of report emailed to the operator
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Yelena AvetisyanTELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2022
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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