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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610582
Report Date: 10/10/2024
Date Signed: 10/10/2024 11:15:50 AM

Document Has Been Signed on 10/10/2024 11:15 AM - 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:DIGNITY SENIOR CARE INC.FACILITY NUMBER:
197610582
ADMINISTRATOR/
DIRECTOR:		SOGHOMONYAN, LALAFACILITY TYPE:
740
ADDRESS:10421 GERALD AVETELEPHONE:
(818) 390-2151
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 0DATE:
10/10/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Lala Soghomonyan, Yeva VardianTIME VISIT/
INSPECTION COMPLETED:
11:30 PM
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Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with the applicant representative/administrator, Lala Soghomonyan and their consultant, Yeva Vardian. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on February 20, 2024. A fire clearance was approved on August 12, 2024 for six (6) ambulatory only residents, for a total capacity of six. The applicant has requested a hospice waiver to retain six (6) residents. The smoke alarms and carbon monoxide detector are dual and inter-connected. The facility has a new fire extinguishers that was purchased on August 6, 2024. It is located by the kitchen.

A tour of the physical plant was initiated at approximately 10:00am, after the Component III presentation. The following was observed:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, stove/oven, microwave oven and sink. No residents in the home at this time, therefore, perishable food items is not required during the inspection. Applicant was advised that they would need to purchase perishable food items, once they admit their first resident. There was an adequate supply of non-perishable food items. Knives will be kept locked in a kitchen drawer. Cleaning supplies will be kept locked in a cabinet under the sink. Medications will be kept locked in another cabinet located in the kitchen.

BEDROOMS: There are three (3) bedrooms designated for client use. All bedrooms will be shared rooms. Bedroom #1 has it's own bathroom. The applicant furnished the resident bedrooms with two beds, two night stands, two chairs, a dresser large enough for two residents in the room to share, bedding and linen. The bedrooms have sufficient lighting and closet space. Additional linens and towels maintained in closet in the hallway.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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: DIGNITY SENIOR CARE INC.
FACILITY NUMBER: 197610582
VISIT DATE: 10/10/2024
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BATHROOMS: The facility has two (2) bathrooms. Bedroom #1 has it's own bathroom with shower and tub. The other bathroom is located in the hallway. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured between 117 and 118 degrees.


COMMON AREAS: These included the living room and dining room. The living room has two couches, a coffee table and television. There is a fireplace, that is screened, but non-functional. No fireplace tools were present. The dining room is located by the entrance. Dining room table is large enough to seat up to six (6) residents. There is an additional refrigerator located near the dining room area.

LAUNDRY ROOM: The laundry room is located by the kitchen. No detergents or cleaning supplies will be kept in this area.

MEDICATIONS: Medications will be kept locked in a kitchen cabinet.

STAFF/RESIDENT RECORDS: There are two filing cabinets located by the dining room where staff and resident records will be maintained and locked.

GARAGE: The garage is attached to the building, but no access from the inside of the home. Only access is outside of the facility, but it is kept locked at all times.

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 a patio area with chairs/seating area for the residents to use. The facility's backyard has sufficient yard space to hold outdoor activities. There are no swimming pools or any other bodies of water.

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

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

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
LIC809 (FAS) - (06/04)
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