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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610300
Report Date: 10/01/2024
Date Signed: 10/01/2024 03:06:34 PM

Document Has Been Signed on 10/01/2024 03:06 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 INCFACILITY NUMBER:
197610300
ADMINISTRATOR/
DIRECTOR:		MELIKYAN, ARMENFACILITY TYPE:
772
ADDRESS:43828 47TH STREET WESTTELEPHONE:
(661) 579-6666
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 6CENSUS: 5DATE:
10/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:21 PM
MET WITH:Marine GuloyanTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 10/01/2024, LPA Evelin Rios arrived at the facility mentioned above to conduct an unannounced annual inspection. LPA was greeted by staff #1 (S1) and granted access. S1 contacted the Program Director, Marine Guloyan and the Executive Director, Armen Melikyan by telephone to inform them LPA was at the facility. At 10:18 a.m. LPA met with Marine Guloyan. LPA explained the reason for the visit. The facility is fire cleared for six (6) ambulatory clients. This is a social rehabilitation short-term crisis residential program facility.

At approximately 9:50 a.m., a tour of the physical plant was initiated with staff #1(S1). LPA observed the following:

Kitchen: The facility has a chef that prepares meals for the clients three times a day. 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. LPA observed emergency food and water. The appliances such as the refrigerator, stove top, microwave and dishwasher were observed operational. There are five (5) fire extinguishers located through out the facility with last serviced date of 05//01/2024.

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 properly furnished with adequate lighting.

Bathrooms: There are four (4) total bathrooms in the facility. Two (2) are meant for client use only. They were properly supplied with toilet paper, hand soap and paper towels. Bathroom appeared to have functional fixtures.

(continued on LIC 809-C)
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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
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: 10/01/2024
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(continued from LIC 809)

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. LPA reviewed medications and medication documentation at 10:00 a.m. Clients Centrally Stored Medication and Destruction Records (CSMDR) are kept electronically and manually. Doctor orders are kept electronically. Staff is able to review medication orders in real time.

Resident Files: At 12:24 p.m. with the assistance of the Program Director, LPA conducted a file review of five (5) resident records for proper documentation. Resident records appeared complete and updated. Files are kept electronically.

Staff Files: At 1:10 p.m. with the assistance of the facility's HR representative Max Cheshoff, LPA conducted a file review of three (3) staff records to insure forms and training are up to date and in compliance. Files are kept electronically.

There are smoke/carbon monoxide detectors hard wired and interconnected through out the facility. Staff#2 (S2) tested the detectors at 1:41 p.m. and they were observed to be operational.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiency were observed during today's visit. Exit Interview Conducted. A copy of the report Issued.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC809 (FAS) - (06/04)
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