197610618-7-9-2024-31-AS-HRAI-D6ZNN3-20240709103603

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610618
Report Date: 07/09/2024
Date Signed: 07/09/2024 10:36:47 AM

Document Has Been Signed on 07/09/2024 10:36 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	RESEDA SENIOR LIVING		FACILITY NUMBER:	197610618
ADMINISTRATOR:	SADOYAN, NELLI		FACILITY TYPE:	740
ADDRESS:	8054 NESTLE AVE		TELEPHONE:	(747) 474-0400
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 0	DATE:	07/09/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Neli Sadoyan, Administrator		TIME COMPLETED:	11:00 AM

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At 09:15 am, Licensing Program Analysts (LPAs), Huma Rahimi conducted an announced Pre-Licensing visit to the above facility and met with Nelli Sadoyan. LPA conducted an entrance interview with the Administrator. At the time of this visit LPAs did not observed any residents present in the facility. Fire Clearance dated 06/05/2024 and received for five (5) Non-ambulatory and one (1) Bedridden (room #2) residents. 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 LPA 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 a sink. Stove was observed in a good working condition. At 09:25am, LPA 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 drawer and inaccessible to residents. Fire Extinguisher was last purchased on 05/15/2024.

MEDICATION ROOM: The centrally stored medication will be kept in the kitchen in a locked cabinet. LPA observed the cabinet locked during the time of the visit.

LAUNDRY ROOM: The laundry room is located next to the kitchen. Laundry and other cleaning supplies are kept inaccessible in a standing closet in the laundry room. LPA observed the closet locked. The washer/dryer appear to be in good condition.

Continue on LIC 809C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

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: RESEDA SENIOR LIVING	FACILITY NUMBER: 197610618
	VISIT DATE: 07/09/2024

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BEDROOMS: There are three (3) bedrooms designated for resident’s use. All bedrooms are shared. Bedroom (2) is used for a bedridden resident. 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 no live-in staff at the facility.

BATHROOMS: There are two bathrooms at the facility of which one is designated for resident’s use. At 9:35am LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and had non-skid mat The water temperature was noted at 120°.

COMMON AREAS: The facility maintains a comfortable temperature at 75°F. The living room and dining area
appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility.

SURROUNDING GROUNDS: The back of the facility has sufficient yard space. LPA did observe appropriate outdoor furniture, LPA observe a covered shaded area for residents. The backyard is fenced. There is no swimming pool or any bodies of water at the facility. The exit was free of any obstruction or hazard.

Garage/Storage: LPA observed that the garage is being used for office supplies storage.

SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 10:05 am 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) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

LIC809 (FAS) - (06/04)

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