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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610225
Report Date: 03/11/2024
Date Signed: 03/11/2024 02:12:50 PM


Document Has Been Signed on 03/11/2024 02:12 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:A SWEET HOME CAREFACILITY NUMBER:
197610225
ADMINISTRATOR:KARAPETYAN, DIANAFACILITY TYPE:
740
ADDRESS:25141 HIGHSPRING AVE.TELEPHONE:
(818) 606-8707
CITY:NEWHALLSTATE: CAZIP CODE:
91321
CAPACITY:6CENSUS: 5DATE:
03/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Lida Gaspryan & Diana KarapetyanTIME COMPLETED:
02:30 PM
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Licensing Program Analysts (LPA) Tuesday Cabiness arrived at the facility to conduct an annual inspection. LPA was greeted by caregiver Lida Gaspryan, who allowed LPA to enter. LPA observed an additional staff working. Administrator Diana Karapetyan arrived shortly after. Everyone was informed the reason of the visit. A complete inspection/tour of the facility was conducted from the inside and outside. The following was observed during the inspection:

Kitchen: LPA observed Licensing requirement of (7) day nonperishable, and (2) perishable, with extra refrigerator and freezer, stocked with food in the garage. Food was properly wrapped, and appliances were functional, clean, and in good repair. Chemicals, household supplies, and knives, are stored in the kitchen and garage area, they were locked and secured. Living/dining: All indoor passageways were free from obstruction; inside temperature was comfortable, with adequate lighting, and all areas were clean and appropriately furnished for resident’s comfort. Bedrooms: The facility has (4) bedrooms residents; with (1) room for staff. All bedrooms were properly furnished and supplied with appropriate bedding and linens. Bathrooms: There are (2); all were clean, with soap and towels, grab bars, and non-skid mats. Hot water measured 113.0 degrees Fahrenheit. Surrounding Grounds: There were no visible hazards; passageways were free from obstruction and gates were easily accessible to open. The facility has outdoor furniture, with a covered shaded area for residents and visitors. There are no swimming pools or other bodies of water. Laundry detergents, cleaning agents and other toxins are stored in the garage. All exit doors have locks and alarms; all were operating. Fire extinguisher fully charged. First aid kit furnished fully equipped. Smoke alarms and carbon monoxide detectors were tested and operating properly.

Record review: A complete record review of staff and residents and medication records were reviewed.

SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2024
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: A SWEET HOME CARE
FACILITY NUMBER: 197610225
VISIT DATE: 03/11/2024
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Infection/Mitigation Control Review: Upon entry, LPA entered there was a sign-in sheet with a cleaning station, and thermometer. Soap and towels, and hand washing signs were visually posted. Hand washing, coughing etiquette, physical distancing, and other necessary signs were posted in the bathroom and throughout the facility. The facility has sufficient stock of PPE. The facility has cleaning procedures and protocols in place, which include staff cleaning common areas throughout the day. The facility has documentation of all vaccination records for residents.

Exit interview and copy of report provided.

SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024
LIC809 (FAS) - (06/04)
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