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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610300
Report Date: 10/07/2022
Date Signed: 10/07/2022 12:01:08 PM

Document Has Been Signed on 10/07/2022 12:01 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:QUEST BEHAVIORAL HEALTH INCFACILITY NUMBER:
197610300
ADMINISTRATOR:MELIKYAN, ARMENFACILITY TYPE:
772
ADDRESS:43828 47TH STREET WESTTELEPHONE:
(661) 579-6666
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 6CENSUS: 0DATE:
10/07/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Armen MelikyanTIME COMPLETED:
12:15 PM
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On 10/7/2022, Licensing Program Analyst (LPA) Melissa Ruiz conducted an announced Pre-Licensing visit to the facility mentioned above and met with the Administrator Armen Melikyan. An initial application to operate Social Rehabilitation Facility was received. A fire Clearance dated 7/27/2022 was received for six (6) ambulatory residents.

Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: The facility is a two-story building. The facility has a total of three (3) bedrooms, all designated for residents. Resident bedrooms were observed to be appropriately furnished. There are four (4) bathrooms, two of which are designated for residents and the other two (2) for staff. The common areas were appropriately furnished, and lighting was adequate. The living room has a television and comfortable furniture. Resident and staff records will be stored in a locked area in a cabinet in the staff room. Medications will also be stored and locked in cabinet in the medical room. The fire extinguishers were observed throughout the facility and have a date of purchase of 7/27/2022. There are dual smoke and carbon monoxide detectors throughout the facility. There is a functioning telephone on the premises. An emergency exit plan/sketch is posted throughout the facility along with other posting requirements. The first aid kit is readily available. Facility appears to be clean, in good repair and kept at a comfortable temperature of 75°F. Appliances in the kitchen appeared to be functional. Facility maintains a startup amount of one week’s worth of nonperishable food to accommodate a maximum capacity of six (6) residents. There is a shaded sitting area in the fenced backyard. There is a designated laundry room that leads to the attached garage. The laundry room stores linens and cleaning supplies.

(cont. on LIC9099C)

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2022
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 2
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: QUEST BEHAVIORAL HEALTH INC
FACILITY NUMBER: 197610300
VISIT DATE: 10/07/2022
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Pre-Licensing Self-Certification checklist was discussed with Administrator. Applicant/ Administrator has completed component III. This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. Exit interview was conducted with Administrator. A copy of this report was signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC809 (FAS) - (06/04)
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