197610261-9-16-2024-31-AS-HRAI-D96UA8-20240916152419

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610261
Report Date: 09/16/2024
Date Signed: 09/16/2024 03:24:52 PM

Document Has Been Signed on 09/16/2024 03:24 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.RO, 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: 3	DATE:	09/16/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Marine Hovhannisyan, Staff		TIME COMPLETED:	04:00 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

At 9:45 AM Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the staff, Marine Hovhannisyan. Staff contacted the Administrator Narine Ghazaryan, and LPA explained the reason for the visit. The Administrator could not come to the facility and designated the staff to complete the annual inspection with LPA and sign the report. Physical tour was conducted with the staff and LPA observed the following:

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

Kitchen: At approximately, 9:55 AM LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen drawer. The stove hood was clean. All appliances were functional.

Medications: At approximately, 10:00 AM LPA observed medications are centrally stored and locked in a cabinet near the kitchen.

Bedrooms: The facility has four (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. 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 three (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 10:05 AM, LPA measured the water temperature in Bathroom #1 to be 106.7 degrees Fahrenheit. Continue on LIC 809C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALL COMFORT BOARD AND CARE	FACILITY NUMBER: 197610261
	VISIT DATE: 09/16/2024

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
26
27
28
29
30
31
32

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 two (2) storage areas.

Safety: At 10:20 AM, LPA tested the dual function smoke and carbon monoxide detector to be operational. Detectors were hardwired. At 10:35 AM,LPA observed a fully charged fire extinguisher hanging on the kitchen wall purchased on 01/30/2024. The facility uses surveillance cameras on the interior and exterior. At approximately 10:45 AM, LPA tested four (4) out of four (4) auditory alarms to be functional.

Between 2:15 PM to 3:30 PM, LPA reviewed records of three (3) residents and one (1) staff. Residents and staff records appeared to be complete and updated.

No deficiency cited during today's visit.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2