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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610377
Report Date: 03/28/2023
Date Signed: 04/03/2023 07:28:15 AM

Document Has Been Signed on 04/03/2023 07:28 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ASHNAR HOMES 2 INC.FACILITY NUMBER:
197610377
ADMINISTRATOR:HAKOBYAN, MARINEFACILITY TYPE:
735
ADDRESS:10004 LASAINE AVETELEPHONE:
(818) 626-9145
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 4CENSUS: 0DATE:
03/28/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Marine Hakobyan - AdministratorTIME COMPLETED:
11:30 AM
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) Gary Tan conducted an announced Pre licensing visit on this date. LPA met with Licensee representative Marine Hakobyan and Hamik Sahakyan. A Fire Clearance dated 03/20/23 is approved for six (6) ambulatory clients.

LPA toured the facility inside and out at 9:15 AM. Dual smoke and carbon monoxide alarms are hard wired and interconnected. The facility has three (3) client bedrooms, one is shared. Each room is furnished with beds, lights, night stands and seating. One additional (1) bedroom is designated for staff use. Sufficient closet space was observed for each room. Medication will be stored in a cabinet in the kitchen island. Medication storage is equipped with a lock to ensure medications will not be inaccessible to clients. Storage for client and staff records are also observed to be locked in the cabinet in kitchen island. There is a working telephone on the premises.

Common areas were appropriately furnished and lighting was adequate. LPA observed a fully charged fire extinguisher in the dining room bought in 10/25/22. A complete first aid kit was observed in the kitchen. The water temperature in client restrooms was measured at 118.8°F. Appliances in the kitchen were clean and all appeared functional.

Part of the Garage was converted into an office area and storage for supplies. The garage is also used as a Laundry area, new washer and dryer are properly installed. Laundry detergent and other cleaning supplies are stored in a locked cabinet in this area.

(continued to LIC 809-C)
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2023
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
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: ASHNAR HOMES 2 INC.
FACILITY NUMBER: 197610377
VISIT DATE: 03/28/2023
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
26
27
28
29
30
31
32
(continued from LIC 809)

The backyard of the facility was also inspected to ensure compliance. The backyard activity area is free of obstruction. Outdoor furniture is also observed in the patio. There is no body of water in the facility. The exterior passageways and exits were clean and clear of any obstructions. There is a tool shed located in the backyard observed to be locked and inaccessible to residents. No other health and safety hazard present.

This facility is changing its location due to the non-renewal of lease of the current location. Component III is waived upon approval from LPM Naira Margaryan.

The facility appears to be compliant with regulations. A copy of this report will be submitted to the application specialist for final review.

An exit interview was conducted and a copy of this report Issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2