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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610269
Report Date: 10/03/2022
Date Signed: 10/03/2022 01:49:44 PM


Document Has Been Signed on 10/03/2022 01:49 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:HOUSE OF HOPE ASSISTED LIVING, INCFACILITY NUMBER:
197610269
ADMINISTRATOR:ALABERKYAN, GAYANEFACILITY TYPE:
740
ADDRESS:9617 STANWIN AVENUETELEPHONE:
(818) 302-6344
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY:6CENSUS: 2DATE:
10/03/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Geyane Alaberkyan TIME COMPLETED:
02:00 PM
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At 10:40 am Licensing Program Analyst (LPA) Tihesha Smith conducted an announced pre-licensing visit with administrator Gayane Alaberkyan. The facility has a capacity of six (6). This is a change of name and ownership application, therefore there were two (2) clients in care during today’s visit.

Today's site visit consisted of touring the physical plant inside and outside. LPA Smith observed the following:

COVID-19 signs posted outside near the front entrance. The facility has three (3) bedrooms and two (2) bathrooms: one (1) for staff and one (1) clients. Both bathrooms have the required grab bars and non-skid mats and the hot water for the bathrooms is as follows: 115.2- and 109.7-degrees Fahrenheit. The facility has adequate linen, water, perishable, and non-perishable food supplies are adequate. First aid kit: located on kitchen counter is complete. The smoke detectors and carbon monoxide were observed to present and tested to be operable. Fire extinguisher located in kitchen observed to be charged with new receipt. Emergency exiting plan/sketch is posted.

Medications are locked in upper kitchen cabinet observed to be locked an inaccessible to clients. Sharps and toxins locked in drawer and under kitchen sink both observed to be inaccessible to clients. Emergency telephone numbers are on the kitchen wall along with other required posters. There is also a working telephone located on kitchen counter. Facility has working alarms on exit doors. There is a swimming pool on the property observed to be gated, with a lock and inaccessible to clients. There were no immediate health and safety risks observed during the day of inspection.

At time of visit this facility is not ready to be licensed in order to verify Component III requirement.

Exit interview conducted, and a copy report given.


SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha SmithTELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2022
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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