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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610419
Report Date: 06/11/2024
Date Signed: 06/11/2024 01:34:49 PM


Document Has Been Signed on 06/11/2024 01:34 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:ALL STAR CARE INCFACILITY NUMBER:
197610419
ADMINISTRATOR:DARABEDYAN, IVETAFACILITY TYPE:
740
ADDRESS:36240 52 ST EASTTELEPHONE:
(818) 624-6006
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:6CENSUS: 0DATE:
06/11/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:32 AM
MET WITH:Iveta DarabedyanTIME COMPLETED:
12:30 PM
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An Informal Conference was conducted today in the Woodland Hills Adult and Senior Care Regional office. The purpose of this Informal Conference is to discuss the incident that occurred during the month of April, 2024.

Present at today's meeting are the following:
· Troy Agard, Licensing Program Manager (LPM)
· Melissa Spaeth, Licensing Program Analyst (LPA)
· Iveta Darabedyan – Administrator/Licensee

The informal conference process was explained to the Licensee. The Licensee was also informed that this Informal Conference is a part of the administrative action process. Further citations may result in a Non-Compliance Conference, which could lead to a referral to the Department's Legal Division for possible license revocation or other administrative actions.



BRIEF HISTORY: Facility has been in operation since licensure on 5/15/2023 and is licensed for six non-ambulatory residents, one of which may be bedridden.

A complaint was received by CCL on 6/02/2024. Licensing Program Analyst (LPA) Melissa Spaeth initiated a complaint investigation on 6/06/2024, arrived at the facility at 9:45 am and stated the purpose of the visit was to investigate a complaint.



Continued on 809-C
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Melissa SpaethTELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024
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: ALL STAR CARE INC
FACILITY NUMBER: 197610419
VISIT DATE: 06/11/2024
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LPA Spaeth and the Licensee toured the facility at 10:00 am to 10:15 am. LPA observed there were no residents living in the facility. The Licensee stated there were four residents living in the facility. However, the residents moved out during the month of April, 2024. LPA Spaeth requested to review the residents’ documents. The Administrator stated they did not obtain all the required documentation when the residents moved into the facility. The Administrator stated a verbal eviction notice was given to all four residents but not a written notification.

LPM Agard discussed and expressed concerns regarding the April, 2024 incident. LPM Agard also expressed concerns that the Administrator failed to obtain the required resident documentation and failed to give the residents a written eviction notice.

The Licensee was informed that Community Care Licensing (CCL) shall continue to frequently monitor the facility as often as necessary to ensure the Licensee's compliance with Title 22 Regulations



Exit interview conducted, and a copy of the report was given.
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Melissa SpaethTELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
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