197610261-8-12-2022-31-AS-NRED-CH8R4Z-20220812124222

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610261
Report Date: 08/12/2022
Date Signed: 08/12/2022 12:42:56 PM

Document Has Been Signed on 08/12/2022 12:42 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:	ALL COMFORT BOARD AND CARE		FACILITY NUMBER:	197610261
ADMINISTRATOR:	GHAZARYAN, NARINE		FACILITY TYPE:	740
ADDRESS:	18757 GAULT STREET		TELEPHONE:	(323) 823-9000
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 0	DATE:	08/12/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Narine Ghazaryan		TIME COMPLETED:	12:52 PM

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At 9:45 a.m. on 08/12/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an announced prelicensing visit. LPA met with Licensee Narine Ghazaryan and Lusine Tadevosian and disclosed the reason for the visit. LPA and Licensee toured the facility inside and out.

It is a single story building with 4 bedrooms, 3 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 residents, of which 5 may be non-ambulatory and 1 may be bedridden in Bedroom #4. The facility plans to serve residents with dementia.

Entry: LPA observed a maintained front yard. Once inside, LPA observed postings for Resident Rights, Non-Discrimination Policy, Confidential Complaints, Administrator Certificate, Emergency Disaster Plan, and Grievance Procedures.

Common Areas: Walls, floors, ceilings, windows, and blinds were clean and in good repair. At 10:02 a.m. LPA measured the room temperature to be 77 degrees Fahrenheit. A fire door separated the living room from the bedrooms.

Bedrooms: The facility has 4 bedrooms. Bedroom #1 and Bedroom #2 are private. Bedroom #3 and Bedroom #4 are shared. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. A window screen in Bedroom #2 was slightly bent. Licensee to complete the necessary repairs. LPA also observed an adequate supply of fresh linens and hygiene supplies in the closet. The ramp leading our from Bedroom #4 was in good repair.

Bathrooms: The facility has 3 bathrooms. All bathrooms contained liquid soap, paper towels, grab bars near the toilet and shower, and a non-skid mat in the shower. At 10:13 a.m. LPA measured the water temperature in Bathroom #1 to be 87.8 degrees Fahrenheit. Licensee agreed to adjust the water heater and provide proof of correction.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

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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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: ALL COMFORT BOARD AND CARE	FACILITY NUMBER: 197610261
	VISIT DATE: 08/12/2022

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Kitchen: LPA observed an adequate supply of non-perishable food. At 10:44 a.m. LPA measured the refrigerator and freezer temperatures to be 40 and 0 degrees Fahrenheit, respectively. The refrigerator contained a lockbox for medication. The stove hood was clean. All appliances were functional. Cleaning solutions were locked below the sink. Sharps were locked under the counter. Medications were locked near the kitchen. A first aid kit with tweezers, thermometer, dressings, bandages, scissors, and an approved manual was on top of the medication cabinet.

Laundry: A functional washer and dryer were located outside of Bedroom #2. Detergents were locked separately near the appliances.

Outdoor areas: A covered patio area contained furniture and drapes in good condition. The backyard was free of debris. All emergency exit paths were free of obstructions, and all exits were unlocked. LPA observed 2 storage areas. The smaller storage area was located near the laundry area. The larger storage area is the room at the rear of the facility, accessible from the back yard.

Safety: The Emergency Disaster Plan was posted at the front. Each bedroom had a facility sketch with exit routes clearly labelled At 10:00 a.m. LPA tested the dual function smoke and carbon monoxide detector to be operational. Detectors were hardwired. At 11:23 a.m. LPA observed a fully charged fire extinguisher in the kitchen. A receipt from 03/07/2022 was posted on the extinguisher. The facility uses surveillance cameras on the interior and exterior. At approximately 11:30 a.m. LPA tested 4 out of 4 auditory alarms to be functional.

LPA and Licensee completed Component III during the visit.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

LIC809 (FAS) - (06/04)

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