<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610365
Report Date: 03/23/2023
Date Signed: 03/23/2023 01:00:50 PM


Document Has Been Signed on 03/23/2023 01:00 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 CAREFACILITY NUMBER:
197610365
ADMINISTRATOR:TADEVOSYAN, LUSINEFACILITY TYPE:
740
ADDRESS:8403 HILLVIEW AVETELEPHONE:
(818) 436-2250
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY:6CENSUS: 4DATE:
03/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Hrachina Martirosian, DesigneeTIME COMPLETED:
01:20 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) Shira Stamps conducted a Case Management visit to address the letter received by the Department stating there is a change of ownership. LPA spoke to the new Licensee over the phone and explained the purpose of the visit. The New Licensee arrived at 11:56am, and stated the old Licensee is available over phone.

LPA conducted a physical plant tour of the facility and conducted interviews from 11:30am -11:50am. LPA found sufficient amounts of foods. At 11:45am, LPA observed a draw obtaining scissors and knives to be unlocked and accessible to residents in care. The caregiver immediately locked the draw. At 12:26pm, LPA observed the garage door to be unlocked obtaining chemicals. The door was immediately locked. Interviews with four (4) out of four (4) residents indicated the food is good and they can receive seconds if wanted. All residents indicated staff treat them well, and their needs are being taken care of. One (1) out of four (4) residents indicated every now and then staff do not completely do their job, but that most of the time staff do a good job. An over the phone interview with the current Licensee indicated she will continue to work in the facility until the new Licensee is approved. She indicated the residents will be notified thirty (30) days prior to the change of ownership with a written letter. At 12:15pm, LPA observed in the resident’s files the letter notifying the residents of the change of ownership.

Exit interview conducted. Citations issued. Report delivered to Administrator via email.

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Shira StampsTELEPHONE: (818) 669-6375
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2023
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


Document Has Been Signed on 03/23/2023 01:00 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/24/2023
Section Cited

1
2
3
4
5
6
7
87705 Care of Persons with Dementia

(f) The following shall be stored inaccessible to residents with dementia:
(1) Knives,... (2) ... cleaning supplies and disinfectants.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The administrator has agreed to lock all the sharps and chemicals. Knives were immediately removed and locked, and the garage was immediately locked. The Administrator agreed to keep garage door and the kitchen draw locked at all times.
8
9
10
11
12
13
14
Based on observation, the licensee did not comply with the section cited above. LPA observed the sharp knives, sissors, and chemicals to be accessible to residents in care. This is an immediate health and safety risk to residents care.
8
9
10
11
12
13
14
A training will be provided to all staff on the importance of maintaining chemicals and knives and sharp items inaccessible. The administrator shall submit staff sign in sheet with the topic and the training material along with pictures and or receipts by the POC due date.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Shira StampsTELEPHONE: (818) 669-6375
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2