197610441-9-22-2023-31-AS-APAA-CVWQAC-20230922115944

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610441
Report Date: 09/22/2023
Date Signed: 09/22/2023 12:00:35 PM

Document Has Been Signed on 09/22/2023 12:00 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:	A NEW LIFE BOARD AND CARE		FACILITY NUMBER:	197610441
ADMINISTRATOR:	KARAPETYAN, DIANA		FACILITY TYPE:	740
ADDRESS:	19435 STRATHERN ST		TELEPHONE:	(747) 237-2337
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 5	DATE:	09/22/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Diana Karapetyan, Administrator		TIME COMPLETED:	12:25 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

At 10:00am, Licensing Program Analysts (LPAs), Angela Panushkina, Huma Rahimi and Leslie Ngo-Castaneda conducted an announced Pre-Licensing visit to the above facility and met with Administrator Diana Karapetyan. This is a change of ownership application from (Facility #197609030) to (Facility #197610441). LPA team conducted an entrance interview with the Administrator. At the time of this visit LPAs observed and assessed five (5) residents present in the facility. All residents appear to be clean and groomed. Fire Clearance dated 08/04/2023 and received for five (5) Non-ambulatory and one (1) Bedridden (room #5) residents. In addition, approved Hospice waiver for six (6) residents was received on 08/29/2023. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. The facility is a single-story building. Today's site visit consisted of LPAs touring the physical plant inside and outside and observed the following:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. At 10:15am, LPAs observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to residents. Fire Extinguisher was last purchased on 06/13/23.

BEDROOMS: There are five (4) bedrooms designated for residents use. All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational. Facility will have a live-in staff and one (1) bedroom is designated for staff use only.

BATHROOMS: At 10:25am LPAs observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPAs observed appropriate grab bar and had non-skid mat.

COMMON AREAS: The facility maintains a comfortable temperature at 72°F. The living room and dining area
Continue on LIC809-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023

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: A NEW LIFE BOARD AND CARE	FACILITY NUMBER: 197610441
	VISIT DATE: 09/22/2023

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

appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility.

MEDICATION ROOM: The medication and facility staff/resident files will be kept in a locked cabinet located kitchen cabinet.

LAUNDRY ROOM: The laundry room is located outside by bedroom #1 and LPAs observed combination lock on the door. The washer/dryer appear to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision.

SURROUNDING GROUNDS: The back of the facility has sufficient yard space. LPAs observed appropriate outdoor furniture, with a covered shaded area for residents. The backyard is fenced. LPAs discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water. The garage is attached and currently being used for storage.

SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 11:00am they were tested and observed to be operational.

Component III was conducted with the Administrator.

Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and be notified by the CAB Analyst when your license has been approved.

Exit interview was conducted and with a copy of this report was provided to the Applicant/Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2