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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610305
Report Date: 10/12/2024
Date Signed: 10/12/2024 01:08:00 PM

Document Has Been Signed on 10/12/2024 01:08 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:BRIGHTSTAR SENIOR CARE,INCFACILITY NUMBER:
197610305
ADMINISTRATOR/
DIRECTOR:
ALLAHDADI, AYEDEHFACILITY TYPE:
740
ADDRESS:10455 GAYNOR AVETELEPHONE:
(818) 517-0544
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: DATE:
10/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Zinaida SafaryanTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Zinaida Safaryan and advised her of the of the annual inspection.

At approximately 9:20am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are battery operated. The carbon monoxide detector functions properly. The fire extinguisher is located in the kitchen, was purchased on 07/29/24.

Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. There is an additional table, in the kitchen, for staff use only.

Bedrooms: The facility is a two story building. There is a total of six (6) bedrooms. Four (4) bedrooms designated for resident use are located on the downstairs level. Bedrooms #1 and #2 are shared. Bedrooms #3 and #4 are private. The second story has two bedrooms designated for staff only. There is a child proof gate at the front of the stairs on the first floor, that restricts access, denying resident to pass. All four bedrooms, designated for resident use were observed to be furnished with appropriate beddings and linens with sufficient lighting. There is a closet that holds linen and towels in the hallway.

Bathrooms: There are three (3) bathrooms designated for residents' use. All three are common, and for resident and guest use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured between 116 and 120 degrees Fahrenheit.

Common Areas: These included the living room and dining area. The living room is furnished with a couch, chair, coffee table and television. The dining room area is adjacent to the living room. There is a table
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2024
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BRIGHTSTAR SENIOR CARE,INC
FACILITY NUMBER: 197610305
VISIT DATE: 10/12/2024
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large enough to accommodate up to six (6) residents. There is a fireplace that is properly screened. The fireplace is non-functional. No key to the fireplace, and fireplace tools were not present. Furniture in both the living room and dining room were in good repair. The floors in the common areas and hallways were mopped and clean. The auditory alarms on all exit doors were on and functional at the time of the visit.

Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor
use. The backyard has a large enough space to hold outdoor activities. There is no swimming pool or any other bodies of water.

Garage: The garage is attached to the house, but only entry is outside. Entry to the garage is kept locked. The laundry area is located in the garage. Laundry detergents and cleaning supplies are kept in the garage.

Staff Workstation: There is a desk located by the living room. LPA observed a sign in log at this area as well.

Resident Records: Resident records are maintained locked on the second floor.

Staff Records: Staff records are also maintained and locked on the second floor.

Medications: Medications are kept locked in a closet, by the entrance and across the kitchen. Medications and medications records were reviewed for proper storage and documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit Interview Conducted, and a Copy of the Report Issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2024
LIC809 (FAS) - (06/04)
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