197610300-10-23-2023-31-AS-ERIS-CWVT6Y-20231023142755

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610300
Report Date: 10/23/2023
Date Signed: 10/23/2023 02:28:02 PM

Document Has Been Signed on 10/23/2023 02:28 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	QUEST BEHAVIORAL HEALTH INC		FACILITY NUMBER:	197610300
ADMINISTRATOR:	MELIKYAN, ARMEN		FACILITY TYPE:	772
ADDRESS:	43828 47TH STREET WEST		TELEPHONE:	(661) 579-6666
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY: 6		CENSUS: 4	DATE:	10/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Program Director Marine Guloyan		TIME COMPLETED:	02:35 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) Evelin Rios conducted an unannounced annual required visit at this facility. LPA met with Executive Director Armen Melikyan and Program Director Marine Guloyan and explained the reason for the visit. At approximately 10:30 a.m., a tour of the physical plant was initiated with staff #1(S1). The facility is fire cleared for six (6) ambulatory clients. This is a social rehabilitation short-term crisis residential program facility. There are five (5) fire extinguishers located through out the facility with last serviced date of 10/01/2023. The facility is equipped with a sprinkler system. The facility temperatures was set at a comfortable 72°F. There are smoke/carbon monoxide detectors hard wired and interconnected through out the facility. Staff#2 (S2) tested the detectors at 10:52 a.m. and they were observed to be operational. Infection Control: Facility continues to follow their Infection Control Plan. The facility has sufficient stock of PPE in the facility. Kitchen: The facility has a chef that prepares meals for the clients. The kitchen was observed clean and clear of clutter. LPA observed a two-day supply of perishable and seven-day supply of nonperishable food, properly stored. The appliances and fixtures were operational. Bedrooms: There are a total of three (3) bedrooms in the facility for client use, one (1) on the ground floor and two (2) on the second floor, all are shared. LPA observed bedrooms to be clean and properly furnished with adequate lighting. LPA observed additional bedding and linens sufficient for all of the clients. (continued on LIC 809-C)

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: QUEST BEHAVIORAL HEALTH INC	FACILITY NUMBER: 197610300
	VISIT DATE: 10/23/2023

NARRATIVE

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(continued from LIC 809)

Bathrooms: There are four (4) total bathrooms in the facility. Two (2) are meant for client use only. They were properly supplied and had functional fixtures. Hot water temperature in the upstairs bathroom was checked and measured 119.1°F which is within the required range.

Common Areas: Common areas, include the living area, dining area, gym and offices. Areas were observed clean and properly furnished to accommodate the capacity of the facility. The laundry room is maintained locked and leads to a garage that is used as a gym. Laundry detergents, cleaning chemicals and sharps were observed locked in the laundry room.

Surrounding Grounds: Entry/exits were free from obstructions. The outdoor area was clean and had appropriate outdoor furniture for client use. There is no body of water in the facility.

Medications: Medications were locked in a cabinet in the designated medication office which is also kept locked. Medications were observed properly labeled and stored. There is a small refrigerator where medication requiring refrigeration is kept. LPA observed refrigerator locked as well. LPA reviewed medications and medication documentation at 10:55 a.m. and it was observed to be complete. Clients centrally stored medication records are kept electronically and physically. There is a first aid kit located in the medication room.

Resident Files: With the assistance of the Program Director, LPA conducted a file review of resident records for proper documentation. Resident records appeared complete and updated. Files are kept electronically.

Staff Files: With the assistance of the facility's HR representative Max Cheshoff, LPA conducted a file review of staff records to insure forms and training are up to date and in compliance. Files are kept electronically.

There were no health and safety issue observed during todays visit. Exit interview conducted. Copy of this report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

LIC809 (FAS) - (06/04)

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