197610365-1-12-2023-31-AS-MSPH-CMZTKA-20230112134735

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610365
Report Date: 01/12/2023
Date Signed: 01/12/2023 01:47:47 PM

Document Has Been Signed on 01/12/2023 01:47 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:	NEW HOPE SENIOR CARE		FACILITY NUMBER:	197610365
ADMINISTRATOR:	TADEVOSYAN, LUSINE		FACILITY TYPE:	740
ADDRESS:	8403 HILLVIEW AVE		TELEPHONE:	(818) 436-2250
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91304
CAPACITY:	6	CENSUS: 0	DATE:	01/12/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Vahan Aghabekyan and Lusine Tadevosyan		TIME COMPLETED:	12:30 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	LPA conducted a pre-licensing visit and Comp III presentation at the facility with Administrators. LPA observed the COVID sign posted on the front door. Upon entry, LPA observed Administrators were wearing masks. LPA was asked to sign in at the sign in station. LPA observed thermometer, surgical masks, gloves, hand sanitizer, and sign in sheet at the front entrance. LPA conducted the COMP III presentation at 10:15 until 11:00 am. LPA and the Administrators toured the facility at 10:20 am until 11:00 am. Living Room/Dining Room - LPA observed the living room and dining room are combined. The dining room section contains a dining room table and chairs. The living room contains comfortable seating and a television. Kitchen - LPA observed the knives locked in a kitchen drawer, hand soap, paper towels, and trash can are located near the sink. The cabinet beneath the sink is locked and contains dish soap. LPA observed a seven day supply of non-perishable food and a two-day supply of perishable food items. There is an adequate supply of plates, silver wear, and glasses. The fire extinguisher and first aid kit are also located within the kitchen area. The facility office is also located within the area and contained a two drawer locked cabinet which will contain the residents' files. LPA observed a locked closet in the hallway which will be the designated location for medications. Residents' rooms - There are four residents' rooms which contained bed, linens, night lamp, night stand chest of drawers, and chair. LPA observed adequate lighting in each room. Bathrooms - There are two bathrooms in the facility. Each bathroom contains a walk in shower, slip resistant mat, grab bars, hand soap, paper towels, trash can, and wash your hands sign.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: NEW HOPE SENIOR CARE	FACILITY NUMBER: 197610365
	VISIT DATE: 01/12/2023

NARRATIVE

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Garage - LPA observed the garage was locked and contained the washer, dryer, and cleaning supplies.

Backyard area - LPA observed the backyard contained comfortable seating in a shaded area. The side gate leading from the backyard to the front yard was not locked.

Exit Doors - LPA observed there are three exits in the facility. The Administrator opened all three doors for LPA at 10:45 am and LPA observed the alarm notification was working on all three exit doors.

Fire Alarm/Carbon Monoxide - The Administrator tested the fire/carbon monoxide alarms for LPA at 11:10 am and the alarms were properly working.

Water Temperature - At 11:45 am, LPA tested the water temperature which was recorded to be 108.0 F.

LPA concluded the pre-licensing inspection at 12:30 pm and there are no deficiencies to report at this time. Exit interview conducted and a copy of the signed report was given to the Administrators.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC809 (FAS) - (06/04)

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