198603127-3-21-2025-31-AS-AAEA-DEYVNJ-20250321163512

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603127
Report Date: 03/21/2025
Date Signed: 03/21/2025 04:37:31 PM

Document Has Been Signed on 03/21/2025 04:37 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:	ALAMEDA BOARD & CARE		FACILITY NUMBER:	198603127
ADMINISTRATOR/ DIRECTOR:	AVETISYAN, ARMENUHI		FACILITY TYPE:	740
ADDRESS:	1129 ALAMEDA AVE		TELEPHONE:	(213) 595-2777
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91201
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	03/21/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Caregiver, Kristina Tonoyan & Licensee/Administrator Yelena Amirjanyan		TIME VISIT/ INSPECTION COMPLETED:	04:45 PM

NARRATIVE

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At 9:45a.m., Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection to the facility. LPA met with Caregiver and explained the reason for the visit. Caregiver contacted Licensee/ Administrator via-phone. At approximately 10:15a.m.,Licensee/Administrator joined today’s visit.

At 10:25a.m., Administrator and LPA conducted physical plant tour inside and out. During the tour, LPA observed that the facility is a single -story home in a residential community. The front main door is the only entrance being utilized at the facility, it has three (03) bedrooms and two (02) bathrooms designated for residents and one (01) staff bathroom. Three (03) shared rooms designated for residents. Fire/Earthquake drill was last conducted on 01/07/2025. Required posting observed displayed in the facility dining area (complaint hot line poster, personal rights, etc). Temperature of facility wall thermostat is observed and set to 70 degrees Fahrenheit. The fire alarm system was tested and observed to be working, it is hard wired and interconnected. No obstructions and or tripping hazards throughout the facility.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Common Areas: These included the living room and dining area for residents. The common areas were properly furnished and in good repair. Residents dining table fits eight (08) residents. Bedrooms were toured and observed to be clean and properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Linen storage was also checked and observed to have ample supply of clean linen, comforters, and towels in facility. Staff bedrooms are designated only for live in staff. Every bedroom, dining and hallway areas has smoke detectors that are functional. Bathrooms were observed to be clean, sanitary and with necessary supplies. The appropriate grab bars and mats in the shower. Hot water temperature measured at a range of 113.5°F to 116.9°F and within the required range.

(Continued to LIC 809-C)

Naira Margaryan	TELEPHONE: (818) 596-4368
Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
	DATE: 03/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025

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: ALAMEDA BOARD & CARE	FACILITY NUMBER: 198603127
	VISIT DATE: 03/21/2025

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(Continued from LIC 809)

Resident’s personal hygiene supplied are kept separate in residents restroom cabinet. Towels and washcloths are not shared. Kitchen Area is observed to be clean and sanitary. Sharps are locked and stored in kitchen cabinet. Toxins, soap, and cleaning solutions are stored and locked in the back of facility in shed. Fire extinguisher were observed to be located in the dining area. Fire extinguisher were observed to be operable with purchased date of 02/15/2025. Food: LPA observed at least two (02) days perishable and seven (07) days non-perishable food at the facility that is properly stored. Frozen foods are wrap and stored properly as well. Food storage and preparation areas are clean. Medication and first aid kit were observed to be locked in kitchen cabinet inaccessible to residents in care. Garage is attached to the house and observed to be locked and inaccessible to residents. The garage storages extra supplies, laundry detergents and cleaning agents. Laundry Room: LPA observed washer and dryer machines located outside on the back of the facility. Surrounding Grounds The front grounds of the facility are well landscaped. All passageways and stairways were observed to be clear from obstruction. A covered canopy area with a table and chairs for lounging in the back of the facility. The outdoor area was enclosed, and no bodies of water were observed on the premises. Resident Records. Five (05) resident records were reviewed. Resident record are complete and current at this time. Staff Records were also reviewed they all have criminal record clearances, associated to this facility. Staff cardiopulmonary resuscitation (CPR) and first aid training are complete and current at this time. Administrator's certificate was observed to be current.

Based on observation, the licensee converted the recreation room and office into live in staff bedrooms without prior notification to the Licensing Office.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies observed cited on LIC809-D during the visit.

Exit Interview Conducted / A Copy of the Report was provided to Licensee/Administrator.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/21/2025 04:37 PM - It Cannot Be Edited

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: ALAMEDA BOARD & CARE	FACILITY NUMBER: 198603127
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87305(a)

87305(a) Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by: Recreation room and office has been converted in to staff bedrooms. There is no permit for the alteration.
	Deficient Practice Statement
1 2 3 4	Based on inspection and observation, the licensee did not comply with the section cited above. The licensee made alteration to the existing facility without prior notification to the Licensing Office which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/28/2025
	Plan of Correction
1 2 3 4	Licensee will submit new facility sketch including identifying recent changes made to physical plant. In addition written statement will be provided explaining when and how the facility will obtain approved permits for alteration of exisiting bulding as needed.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Naira Margaryan	TELEPHONE: (818) 596-4368
Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
	DATE: 03/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025

LIC809 (FAS) - (06/04)

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