197610441-9-6-2024-31-AS-HRAI-D8V28R-20240906171047

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610441
Report Date: 09/03/2024
Date Signed: 09/06/2024 05:11:27 PM

Document Has Been Signed on 09/06/2024 05:11 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:	A NEW LIFE BOARD AND CARE		FACILITY NUMBER:	197610441
ADMINISTRATOR:	KARAPETYAN, GURGEN		FACILITY TYPE:	740
ADDRESS:	19435 STRATHERN ST		TELEPHONE:	(747) 237-2337
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 6	DATE:	09/03/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Gurgen Karapetyan, Administrator		TIME COMPLETED:	04:00 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 1:45 PM Licensing Program Analysts (LPAs), Huma Rahimi and Leslie Ngo-Castaneda, conducted an unannounced annual inspection at the facility mentioned above. LPAs met with the staff, Marine Abrahamyan and the Administrator Gurgen Karapetyan, Administrator, arrived shortly after. LPAs explained the reason for the visit. Physical tour was conducted with the Administrator and LPAs observed the following: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. At 1:50 PM, LPAs observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). LPAs observed a scissor accessible to residents in care in the kitchen on the counter top by the sink. All other knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to residents. Fire Extinguisher was last purchased on 09/03/2024. 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 a bedroom designated for staff use only. LPAs observed medication bottle in the staff room unlocked and accessible to residents in care. Additionally, LPAs observed medications in bedroom # five (5) in resident's position. BATHROOMS: At 2:10 PM 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. LPAs observed medications in bathroom # 1 which is attached to bedroom number one (1). Continue on LIC809-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

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: A NEW LIFE BOARD AND CARE	FACILITY NUMBER: 197610441
	VISIT DATE: 09/03/2024

NARRATIVE

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COMMON AREAS: The facility maintains a comfortable temperature at 72°F. The living room and dining area appeared clean and were properly furnished. All exits were free of obstruction or hazards.

MEDICATION ROOM: The medication and facility staff/resident files will be kept in a locked cabinet located kitchen cabinet. However, LPAs observed medications (Advil and Alcohol First Aid Antiseptic) accessible to residents in care in bedroom # 5. Additionally, the pantry in the hall was also observed unlocked with medications.

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 and LPAs observed it unlocked with paint and other tools accessible to residents in care.

SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 2:15 PM, they were tested and observed to be operational.

Between 2:30 PM to 3:30 PM, LPAs reviewed records of four (4) residents and two (2) staff. Residents and staff records appeared to be complete and updated.

Administrative: LPAs collected Certificate of Liability Insurance, and LIC500.

A deficiency is cited during today’s visit. Appeal rights explained.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/06/2024 05:11 PM - It Cannot Be Edited

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: A NEW LIFE BOARD AND CARE	FACILITY NUMBER: 197610441
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87705(f)(1)(2)

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents...(1) Knives, matches, firearms...(2) Over-the-counter medication... This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by providing care and supervision to persons with dementia and having sharps, medications, and toxins, accessible to residents in care, which poses an immediate health and safety or pesonal rights risk to persons in care.
	POC Due Date: 09/05/2024
	Plan of Correction
1 2 3 4	Administrator will provide a training to all staff on the importance of maintaining sharps, medications, toxins, and gardening tools accessible to residents in care inaccessible to residents in care. The administrator shall submit staff sign in sheet with the topic and the training material to LPA by POC date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

LIC809 (FAS) - (06/04)

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