197610634-7-30-2024-31-AS-MCAA-D7NPXB-20240730114206

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610634
Report Date: 07/30/2024
Date Signed: 07/30/2024 11:42:16 AM

Document Has Been Signed on 07/30/2024 11:42 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:	WE CARE BOARD AND CARE		FACILITY NUMBER:	197610634
ADMINISTRATOR:	CHAKHMAKHCHYAN, DIANNA		FACILITY TYPE:	740
ADDRESS:	16425 TULSA STREET		TELEPHONE:	(818) 687-1484
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 0	DATE:	07/30/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Dianna & Tina Chakhmakhcyan		TIME COMPLETED:	11:45 AM

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	Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with both applicant representatives Dianna & Tina Chakhmakhcyan. Both also carry an Administrator Certificate. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on May 13, 2024. The facility is a one story building. A fire clearance was approved on June 26, 2024 for five (5) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six (6). The smoke alarms and carbon monoxide detector are dual and inter-connected. The facility has a brand new fire extinguisher that is located by the front entrance. It was purchased May 7, 2024. Prior to the physical plant inspection, a Component III was conducted with both application representatives. A tour of the physical plant was initiated at approximately 9:45am and the following was observed: KITCHEN: The kitchen area is equipped with a refrigerator, brand new stove and sink. Perishable food not required at this time as currently there are no residents, but there were adequate supplies of nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives were observed locked in a cabinet underneath a counter top table, located in the middle of the kitchen. Cleaning supplies will also be kept In a separate cabinet, located underneath that same counter top table. BEDROOMS: There are four (4) bedrooms designated for client use. Bedroom #1 and #2 are private. Bedroom #3 and #4 are shared. Per STD 850, Bedroom #1 has a bedridden fire clearance. The applicant furnished the resident bedrooms with beds, night stand, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space. BATHROOMS: The facility has two and one half (2 1/2) bathrooms. Bedroom #2 has it's own bathroom with shower. The other full bathroom and half bathroom are located in the hallway.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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: WE CARE BOARD AND CARE	FACILITY NUMBER: 197610634
	VISIT DATE: 07/30/2024

NARRATIVE

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The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 105 degrees.

COMMON AREAS: These included the living room and dining area. The living room is equipped with two sofas, two chairs, and a table. There is no fire place. The dining area, which is located adjacent to the living room has a dining room table large enough to seat up to six (6). There is also a television located in the living room/dining area.

LAUNDRY AREA: The laundry area is located outside, at the side of the home. The washer/dryer are brand new. Detergents, cleaning agents will be maintained locked either inside the facility, or a storage shed, located at the backyard of the home.

MEDICATIONS: Medications will be stored and locked in a cabinet, underneath a counter top table, located in the middle of the kitchen.

STAFF/RESIDENT RECORDS: Staff and resident records will be kept locked in a filing cabinet that is located in the living room.

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 and backyard furniture to accommodate the six (6) residents. The facility backyard has sufficient yard space to hold outdoor activities. There is a storage shed, that will be kept closed and locked. There is no swimming pool or any bodies of water. The door and passageway leading to the backyard is also clear of obstruction.

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 Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC809 (FAS) - (06/04)

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