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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610394
Report Date: 07/18/2024
Date Signed: 07/18/2024 06:06:07 PM

Document Has Been Signed on 07/18/2024 06:06 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:CANTARA LUXURY LIVINGFACILITY NUMBER:
197610394
ADMINISTRATOR/
DIRECTOR:		ASIRYAN, AREVHATFACILITY TYPE:
735
ADDRESS:10509 CANTARA STREETTELEPHONE:
(323) 879-5408
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 4CENSUS: 0DATE:
07/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:05 PM
MET WITH:Arevhat Asiryan - AdministratorTIME VISIT/
INSPECTION COMPLETED:
06:06 PM
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A Required Annual visit was conducted today by Licensing Program Analyst (LPA) Gary Tan. LPA met with the Administrator Arevhat Asiryan. The facility has no client at this time as the vendorization application at the North Los Angeles Regional Center is still pending at this time. The facility applied to serve Level 2 clients.

At 3:15 PM, A tour of the physical plant was assessed with the administrator and the following was noted:

The only entrance being utilized is the main front door Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation and Infection plan.

Signs of Covid 19 prevention protocol were posted in the Bulletin Board immediately upon entrance. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom. All trash cans were observed to be with cover. The facility has a designated visitors' area at the back backyard. The facility has sufficient stock of PPE in the storage room.

The facility has a total of four (4) bedrooms and two (2) bathrooms. One (1) bedroom and one (1) bathroom is designated for staff use. There is no body of water in the facility.

Bedrooms were toured and observed to be clean and properly furnished. Linen storage was also checked and observed to have ample supply of clean linen and towels.

Bathrooms were observed to be clean and sanitary with necessary supplies. Hot water temperature was measured at 116.6°F and within the required range.

(continued on LIC 809-C)
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CANTARA LUXURY LIVING
FACILITY NUMBER: 197610394
VISIT DATE: 07/18/2024
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(continued from LIC 809)

Physical plant was checked for cleanliness and condition. Facility was in good repair and observed to be clean and free of clutter during today's visit.
Living and dining room furniture were also checked for functionality (wear and tear). Furniture was observed to be in good condition.
Kitchen area was observed to be clean and sanitary. All the toxins, cleaning solutions and disinfectants are locked in the cabinet along the bedroom hallway beside the laundry machines.
Food. The facility is observed to have sufficient food supply for the clients both perishable and non-perishable.
Temperature of facility wall thermostat is set at 74°F and observed to be within the required range.
Fire extinguisher There is a fire extinguisher located in the dining area. Extinguisher was observed to be full and last bought on 04/02/24. Dual smoke alarms/carbon monoxide are tested and observed to be operational. There is no garage at the facility, only driveway in the front house. There is a tool shed in the backyard and was observed to be locked. Laundry area is located along the bedroom hallway. Laundry soap and other cleaning agents and other toxins were kept in a locked cabinet beside the laundry machines.

Client records. No client at this time.


Staff records were reviewed. Administrator has a current certificate and complete and current record on file.

Medication will be kept in the locked cabinet in the bedroom hallway. There is a complete First Aid kit located in the kitchen.

Required posting are observed to be complete and current and displayed properly at the facility.

There is no health and safety issue during this visit. Exit interview conducted. Copy of this report issued
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC809 (FAS) - (06/04)
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