197610377-3-9-2024-31-AS-GSAO-D37TPZ-20240309135509

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610377
Report Date: 03/09/2024
Date Signed: 03/09/2024 01:55:34 PM

Document Has Been Signed on 03/09/2024 01:55 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	ASHNAR HOMES 2 INC.		FACILITY NUMBER:	197610377
ADMINISTRATOR:	HAKOBYAN, MARINE		FACILITY TYPE:	735
ADDRESS:	10004 LASAINE AVE		TELEPHONE:	(818) 626-9145
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY: 4		CENSUS: 4	DATE:	03/09/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Marine Hakobyan		TIME COMPLETED:	01:45 PM

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On 03/09/24 at 10:05 AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with caregiver Lilit Bahdasarian and disclosed the purpose of the visit. Caregiver Lilit Bahdasarian called the administrator and Marine Hakobyan arrived like fifteen (15) minutes later.

LPA asked for the census, resident, and staff rosters.

A physical tour was conducted at 11:10 AM and observed the following:

The Kitchen area was toured, and LPA observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. There is a telephone line on the counter in the kitchen on your right-hand side. There is extra, food in the kitchen pantries. The first aid kit is on the kitchen counter area on the left-side of the sink. The knives are at the bottom of the kitchen counter on your left-side in a locked black box and inaccessible to the residents. The chemicals are under the sink locked and inaccessible to the residents. The medications are locked and inaccessible to the residents in one of the bottom, cabinets on your right-hand side of the kitchen.

Outside/Backyard: The outside/backyard has furniture for the residents with proper seating. There are three (3) different types of furniture for the residents to seat. There is small shed locked and inaccessible to the residents which contains seasonal items. The facility does have a signal system. The facility does not have a pool/body of water.

LIC 809C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2024

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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ASHNAR HOMES 2 INC.	FACILITY NUMBER: 197610377
	VISIT DATE: 03/09/2024

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The fire extinguisher is located against the wall on your left-hand side of the entrance of the facility. It is fully charged. The expiration date is 03/2024.

Bedrooms: There are four (4) bedrooms and three (3) full bathrooms. Two (2) of the resident’s rooms are single, occupied with no bathroom and one (1) bedroom is shared with no bathroom. There is a staff room that has a private bathroom. There are two (2) other bathrooms accessible for resident use. All bedrooms and bathrooms were toured and were properly furnished and have appropriate bedding, linens, toiletry, and lightning. The bathrooms have proper toiletry, grab bars and non-skid mats. The bathroom temperatures of the water are within regulations reading at 110–113-degree Fahrenheit.

The dining/living room area has enough seating for the residents and the staff. There is a fireplace that is covered and inaccessible to the residents.

There is a pantry/room in the hallway that has extra linen such as towels, sheets. It is locked and inaccessible to the residents. The house temperature is at 71-degree Fahrenheit.

The smoke detector/carbon monoxide is in the hallway and is operable.

There is a garage that is attached to the house which you can access from the kitchen area. There is one (1) washer and dryer. There is an additional refrigerator and a freezer in the garage. There are other cabinets with cereal, canned-goods, toilet paper, hygiene, and masks. There is an additional fire extinguisher on your right-hand side of the garage.

Administrative: The annual fee was recently paid in the amount of $908.00. At the entrance of the facility, there is a billboard with House Rules, Disaster Plan, Personal Rights, YES, Covid signs, grievance, and visitation policy. The surety bond has an expiration date of 04/2024.

An exit interview was conducted, no citations were issued, and a copy of this report was issued to the administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2024

LIC809 (FAS) - (06/04)

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