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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603100
Report Date: 07/24/2024
Date Signed: 07/24/2024 05:13:04 PM

Document Has Been Signed on 07/24/2024 05:13 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:NO PLACE LIKE HOME FOR GOLDEN AGES 2 LLCFACILITY NUMBER:
198603100
ADMINISTRATOR/
DIRECTOR:		TOPADZUIKYAN, EMMAFACILITY TYPE:
740
ADDRESS:1444 WESTERN AVETELEPHONE:
(818) 245-6614
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY: 5CENSUS: 4DATE:
07/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Estellita San Pedro, CaregiverTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced annual visit. LPA met with Caregiver Estellita San Pedro and explained the reason for the visit.

The facility is licensed to serve 5 non-ambulatory residents ages between 60 and over and a hospice waiver for 2 hospice residents. Facility is a one story single home in a residential area and consists of the following: 3 bedrooms, 3 resident bathrooms, 1 staff bathroom, garage, gated pool with pool house. Backyard has an area with tables/ umbrellas for shade. Facility has a living room, kitchen/dining room and front porch. Pool house is inaccessible to residents.

LPA Valenzuela conducted a tour of the facility with Caregiver Estellita San Pedro and observed the following: Living room has a cover fireplace, sufficient sitting area, and signs posted. Medication cabinet is located in the living room and was observed to be locked. Knives and cleaning supplies were observed to be locked under the kitchen sink. Facility has sufficient food supplies for at least 2 days worth of perishables and 7 days of non-perishables. Residents rooms were observed as follows: Room #3 (R3) has all required furniture and bedding, Room #1(R1) and Room #2(R2) have all required furniture, bedding, and sufficient lighting. Water temperature was measured at 120 degrees F, which is not within the required 105-120 degrees F. Smoke/Carbon Monoxide detectors were observed, tested, and in working condition. Fired extinguisher was observed in the kitchen. Files were reviewed for 4 residents. Five staff files were also reviewed.

There is one complete first aid kit.

Continue on 9099-C
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
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: NO PLACE LIKE HOME FOR GOLDEN AGES 2 LLC
FACILITY NUMBER: 198603100
VISIT DATE: 07/24/2024
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No health or safety issues observed at the time of this visit.

Exit interview conducted and a copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC809 (FAS) - (06/04)
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