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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610227
Report Date: 01/27/2022
Date Signed: 01/27/2022 02:48:58 PM

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:GARDEN GROVE ASSISTED LIVING, INCFACILITY NUMBER:
197610227
ADMINISTRATOR:GASPARYAN, ANNAFACILITY TYPE:
740
ADDRESS:8525 GARDEN GROVE AVENUETELEPHONE:
(747) 243-7965
CITY:NORTHRIDGESTATE: CAZIP CODE:
91352
CAPACITY:6CENSUS: 0DATE:
01/27/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Arthur Vahramyan, Sonia GevorkyanTIME COMPLETED:
02:30 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) Wendell Smith conducted a Pre-Licensing Visit. LPA met with applicants at the facility.
Facility is fire cleared for five non-ambulatory and one bedridden resident. Bedroom #3 is to be used for the bedridden resident.
Facility has four bedrooms and two bathrooms. All four bedrooms were appropriately furnished. LPA observed the bathrooms to have grab bars and non skid material. One bathroom is the hallway and the second bathroom is in room #3. LPA observed the kitchen to be prepared to store and serve food. All knives and sharp objects were locked away and inaccessible. There is a fully charged fire extinguisher next to the kitchen area. LPA observed the common area to be appropriately furnished and clean. Comfortable temperature was observed throughout the facility. LPA observed the facility to have extra linen and blankets for the beds. LPA observed the smoke detectors to be working properly. LPA observed a carbon monoxide detectors in the living room area and in the hallway near the bedrooms. LPA checked the backyard and observed it to be free of clutter and debris. LPA observed there to be pool in the backyard which is gated and locked which is inaccessible from clients. LPA observed appropriate exit signs and postings throughout the facility. There were hand-washing and sanitizer stations in the common areas for residents, staff, and visitors to use.
Sonia Gevorkyan will serve as back up administrator and will need to be associated to the facility. The facility telephone number is 818-678-9858, fax number is 818-678-9683
Exit interview conducted. No further action is necessary. LPA will notify Central Application Unit and they will notify the applicant when it is ready to be licensed.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell SmithTELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
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 1