197610223-2-3-2024-31-AS-MCAA-D24V7P-20240203151127

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610223
Report Date: 02/03/2024
Date Signed: 02/03/2024 03:12:04 PM

Document Has Been Signed on 02/03/2024 03:12 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:	NVM COMFORT HOMES		FACILITY NUMBER:	197610223
ADMINISTRATOR:	AGARONYAN, RIMA		FACILITY TYPE:	740
ADDRESS:	16473 MCKEEVER ST		TELEPHONE:	(818) 300-8393
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 6	DATE:	02/03/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:38 AM
MET WITH:	Rima Agaronyan		TIME COMPLETED:	01:00 PM

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) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Rima Agaronyan, and explained the reason for the visit. At approximately 8:45am, with the assistance of the administrator, LPA Cava took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms/Carbon monoxide detectors are dual, and are battery operated. The fire extinguisher is located in the kitchen. The fire extinguisher was purchased on 09/21/23. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives and sharps were stored and maintained inaccessible to the residents in care. Cleaning supplies were stored in a locked cabinet underneath the kitchen sink. Bedrooms: There are four (4) bedrooms designated for residents' use. Two (2) bedrooms are shared and two (2) bedrooms are private. All four bedrooms were observed to be properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms. One bathroom is designated for residents' use, and the other for staff use. The bathroom that is designated for resident use was properly supplied and had functional fixtures. Hot water temperature was measured at 105 degrees Fahrenheit. LPA did not observe any cleaning supplies or hazardous objects maintained in the resident bathroom. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2024

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: NVM COMFORT HOMES	FACILITY NUMBER: 197610223
	VISIT DATE: 02/03/2024

NARRATIVE

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Surrounding Grounds: Entry/exits were free of obstruction and hazard. The front and backyards were maintained and clean. Passageways were clear of obstruction. The backyard had some furniture appropriate for outdoor use.

Staff Workstation: Staff workstation is located adjacent to the kitchen. Computer and printer available for the resident's use.

Garage: The garage is used for additional storage. It is also the laundry area. Entry to the garage is kept locked and inaccessible to residents. LPA observed extra medical supplies and walkers stored in the garage. There is an additional refrigerator where perishable items are maintained. LPA also observed non-perishable supply of food stored in the garage.

Resident Files: Resident files are kept in a cabinet at staff working station. LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: Staff files are kept along with resident files at staff work station. LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Medication and Medication Records are also maintained and locked in the cabinet where resident and staff files are maintained. They were reviewed for proper documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of this report Issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2024

LIC809 (FAS) - (06/04)

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