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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603495
Report Date: 09/02/2022
Date Signed: 09/02/2022 04:54:53 PM


Document Has Been Signed on 09/02/2022 04:54 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:AREGO HOME INCFACILITY NUMBER:
198603495
ADMINISTRATOR:MARKOSIAN, ARMENFACILITY TYPE:
740
ADDRESS:1017 WESTERN AVETELEPHONE:
(818) 913-1742
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY:6CENSUS: 5DATE:
09/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Administrator Armen MarkosianTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Nune Margaryan conducted an annual required visit. LPA met with Administrator Armen Markosian and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed client files, and reviewed staff fingerprint clearances. Facility is approved to retain/accept four (4) hospice residents. There are currently 3 residents on hospice.

The facility is a single story structure located in a residential neighborhood. LPA toured the facility. LPA observed that the facility does not have a swimming pool or other bodies of water. All indoor and outdoor passageways were free of obstruction. There is only one entrance being utilized at the facility, all required posters were posted at the entrance. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing mask during this visit. Home consists of the following: 4 resident bedrooms, 2 bathrooms , living room, dining area, office area, kitchen, laundry area. The front yard is well maintained and has a shaded sitting area / gazebo. All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, light, and sufficient closet space. The resident bathrooms have the required grabs bars and non-skid material / mat. The hot water was 112.2 degrees which is within the required 105 - 120 degrees. The kitchen was inspected. There is sufficient perishable and non-perishable food. All the appliances are clean and seem to be operating properly. Sharps, cleaning supplies are locked and inaccessible to residents.

Continue 809C

SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune MargaryanTELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:
DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/02/2022
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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: AREGO HOME INC
FACILITY NUMBER: 198603495
VISIT DATE: 09/02/2022
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Carbon monoxide detectors were in compliance and operational. Fire extinguishers observed fully charged. LPA observed the centrally stored medication area to be locked and inaccessible to residents. The first aid kit was observed and found to be in compliance with the Title 22 Regulations. LPA reviewed residents records to confirm emergency contact is updated and residents have health screenings on file. Staff records were reviewed to confirm health screenings and fingerprint clearances. LPA reviewed residents medications. Medications are documented properly and given as prescribed.


Per California Code of Regulations, Title 22, there were no deficiencies observed during the visit.

Exit interview was conducted and the copy of the report was provided to the Administrator .

SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune MargaryanTELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022
LIC809 (FAS) - (06/04)
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