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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610450
Report Date: 03/01/2024
Date Signed: 03/01/2024 02:52:29 PM


Document Has Been Signed on 03/01/2024 02:52 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:NEW MILLENNIUM RCFEFACILITY NUMBER:
197610450
ADMINISTRATOR:AVAGYAN, SATENIKFACILITY TYPE:
740
ADDRESS:16210 HALSEY STREETTELEPHONE:
(818) 404-0290
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 0DATE:
03/01/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Satenik Avagyan, Rebeka DurgaryanTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with the applicant representative and administrator, Satenik Avagyan and Rebeka Durgaryan. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on July 1, 2022. A fire clearance was approved on June 14, 2023 for a total capacity of six. The smoke alarms and carbon monoxide detector are dual, hard wired and inter-connected. The facility has two new fire extinguishers that was purchased on October 5, 2023. One fire extinguisher is located in dining room/kitchen area, and the other at the hallway.

A tour of the physical plant was initiated at approximately 1:15pm and the following was observed:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. The Because the facility is brand new, with zero (0) residents, a supply of perishable food not required at this time. LPA did observe an adequate supply of nonperishable food stored in one of the kitchen cabinets.

BEDROOMS: There are four (4) bedrooms designated for client use. Bedroom #1 and #2 are designated for private use. Bedroom #3 and #4 will be shared rooms. The applicant furnished the resident bedrooms with beds, night stand, chairs, dresser, bedding and linen (shared bedrooms had two of each). All bedrooms have sufficient lighting and closet space.

BATHROOMS: The facility has three (3) bathrooms. Two bathrooms are designated for resident use, and one for staff. Bedroom #1 has it's own bathroom. The bathrooms, designated for resident use were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 120 degrees at the time of the visit.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: NEW MILLENNIUM RCFE
FACILITY NUMBER: 197610450
VISIT DATE: 03/01/2024
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COMMON AREAS: These included the living room, dining room and patio areas. Rooms were equipped with living room furniture, a television, tables and chairs. There is a fireplace with a screen slide in the dining area. It is non-operational, with the key stored and inaccessible to residents. Also, there was no tools for the fireplace accessible or in the open at the time of the visit. The dining area has a large dining room table to accommodate six (6). There were no visible immediate hazards.

LAUNDRY Area: The laundry area is located in the enclosed patio area. There is a sink next to the washer and dryer. No cleaning supplies will be maintained there.

MEDICATIONS: Medications and medication records will be kept locked in the hallway closet.

Staff/Resident files: Staff and resident files will be maintained in the same closet where medications will be kept.

SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has an enclosed patio area with furniture to accommodate the six (6) residents. There is a storage space, which one side will be locked at all times, and another side of the storage space, has no lock, but applicant is advised not to maintain any sharps or hazardous items in. There is a swimming pool that is fenced all around with a gate that will be kept locked at all times. The fence surrounding the swimming pool is approximately 5 feet high all around its parameters.

In addition to the Pre-Licensing inspection, a Component III power point presentation was also held.

Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
LIC809 (FAS) - (06/04)
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