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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610353
Report Date: 07/11/2024
Date Signed: 07/12/2024 11:03:39 AM


Document Has Been Signed on 07/12/2024 11:03 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:CACTUS FRONT HOMES LLCFACILITY NUMBER:
197610353
ADMINISTRATOR:NAZARYAN, ANTUANFACILITY TYPE:
740
ADDRESS:10187 WEALTHA AVETELEPHONE:
(818) 292-2087
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY:6CENSUS: 4DATE:
07/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Antuan Nazaryan, AdministratorTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Leizl de la Cerra conducted an annual required visit and inspection of the facility. At 10:00AM Antuan Nazaryan facility administrator met LPA at the entrance and LPA explained the reason for the visit. At 10:05AM, required records were requested.
Resident and Staff Records reviews and interviews: At approximately 10:15AM four 12:30AM four (4) out four (4) resident records and four (4) staff records were reviewed to ensure compliance. Interview of one (1) staff was conducted. Interview of two (2) residents were conducted.

At 12:30PM LPA with the assistance of the administrator took a tour of the facility.
Common Area: LPA observed the living room and furniture to be clean and in good repair. The fireplace located in the living room is adequately closed and inaccessible to residents. The facility maintains a comfortable temperature at 77 degrees Fahrenheit. The air conditioner is operational. The facility smoke alarm system is hard wired and interconnected. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. At 1:15PM they were tested and deemed operational. Facility maintains a telephone land line and it was observed to be operational. Required postings were observed in the hallway. The fire extinguisher is in the kitchen with purchase date of 7/11/2024. The facility is fire cleared for six (06) non-ambulatory residents; one (1) maybe bedridden in bedroom #3 approve for four (4) hospice waiver.

Kitchen: The kitchen appliances were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough food for at least three (3) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods and refrigerated foods are wrapped, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Food preparation areas are clean. Garbage cans have tight fitting covers. Kitchen cleaning supplies were stored in a locked cabinet. Residents' dining table fits enough for six (6) people.


-Continue to LIC 809-C
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Leizl De La CerraTELEPHONE: (818) 454-0632
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CACTUS FRONT HOMES LLC
FACILITY NUMBER: 197610353
VISIT DATE: 07/11/2024
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Bedrooms: There are three (3) bedrooms that were properly furnished with appropriate dresser, night stand, chair, beddings, and linens with sufficient lighting. Extra linens and beddings are stored in the hallway closet.
Bathrooms: There are two (2) bathrooms designated for residents use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 116.8 degrees.
Surrounding Grounds: There is a covered patio with furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have any bodies of water. The garage is attached but does not have a connecting door to access inside the house. Garage is used for storing extra food supplies, toiletries, PPE supplies, and incontinence supplies. Facility has a washer and dryer located inside the garage. Laundry chemicals are stored in the garage. The garage has a lock and will remain locked and inaccessible to residents in care.
LPA reviewed the facility's dementia plan of care and LPA observed that the facility is in accordance with the plan. The LPA observed that the facility is a fenced facility with self-closing latches and gates. All exterior doors for the front, back and client rooms are equipped with an operational bell/buzzer system to alert staff when door is being opened. These devices are set off by motion of the door. Passageways observed to be unblocked. In addition, administrator informed LPA that knobs on the stove are removed during the night time.
LPA observed a locked cabinet that contains all the residents' records, the staff records and the residents' medications. LPA observed the cabinet with top and bottom locks which is inaccessible to residents in care. First-aid has all proper items and is current.

The facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed during today’s visit. Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Leizl De La CerraTELEPHONE: (818) 454-0632
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC809 (FAS) - (06/04)
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