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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603605
Report Date: 01/29/2025
Date Signed: 01/29/2025 11:53:55 AM

Document Has Been Signed on 01/29/2025 11:53 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ARARAT GARDENSFACILITY NUMBER:
198603605
ADMINISTRATOR/
DIRECTOR:		KESHISHYAN, VARSENIKFACILITY TYPE:
741
ADDRESS:1230 EAST WINDSOR ROADTELEPHONE:
(818) 244-7219
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY: 175CENSUS: 86DATE:
01/29/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Charles Brugh-Executive Director TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Leslie Ngo-Castaneda met with Charles Brugh, Executive Director at 10:25 AM for a plan of correction visit. The purpose of the Plan of correction is to correct deficiencies issued last visit on 12.26.2024.

Entrance interview conducted.

Plan of correction visit:

During the tour of the facility at 10:30AM. LPA requested that for the resident roster. LPA visited and confirmed residents who are in need of switching from ambulatory to non-ambulatory rooms.

At 10:30 AM LPA toured bedrooms #2, #14, #111, #118, #119, #122, #123, #206, and #209. LPA observed the bedrooms to be clean and residents are happy with their new bedrooms.

Plan of correction letters issued this visit.

Exit interview conducted.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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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