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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603213
Report Date: 10/03/2024
Date Signed: 10/03/2024 03:09:08 PM


Document Has Been Signed on 10/03/2024 03:09 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:COMFORT CARE ASSISTED LIVING FACILITYFACILITY NUMBER:
198603213
ADMINISTRATOR:AVETIKYAN, OLGAFACILITY TYPE:
740
ADDRESS:731 MILFORD STREETTELEPHONE:
(747) 283-6125
CITY:GLENDALESTATE: CAZIP CODE:
91203
CAPACITY:6CENSUS: 5DATE:
10/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Susanna Avetian, ManagerTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced Required- 1 year visit. LPA met with House Manager Susanna Avietian and explained the purpose of the visit.

Structure:
Facility is a one-story family home with four (4) bedrooms, two (2) full bathrooms, one (1) 1/2 bathroom; living room / dining area, and kitchen. There is a small office located next to front door. Staff and residents’ files are locked and inaccessible. Bedrooms 1, 2 and 4 have direct exits. All exits are equipped with auditory devices with alert feature to monitor exits. Front yard landscape is in good condition at time of visit. Washer/Dryer appliances are in laundry area. Bedrooms #1, 2, 3, and 4 are approved for non-ambulatory clients and bedroom # 1, 2, or 4 can be bedridden. All bedrooms are clean and completely furnished. The bathrooms are clean and operational w/grab bars and non-skid surface/mats in place. The hot water temperature was tested throughout the facility and maintained within the required range of 118.1*F. The fire extinguisher was last serviced in January of 2024. Fire detector is operable as well as carbon monoxide detectors. The backyard has a shaded area with furniture. There are no bodies of water. There is sufficient perishable and non-perishable food. Hazardous chemicals are kept locked under the kitchen sink and are inaccessible to residents in care. There is one complete first aid kit.

No health and safety issues noted at the time of this visit.

Exit interview conducted and a copy of the report was issued.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2024
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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