565850066-1-28-2025-29-AS-ZCHN-DDD3TC-20250128173143

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850066
Report Date: 01/28/2025
Date Signed: 01/28/2025 05:33:09 PM

Document Has Been Signed on 01/28/2025 05:33 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	MEADOWGLADE, THE		FACILITY NUMBER:	565850066
ADMINISTRATOR/ DIRECTOR:	NARINE BABIKIAN		FACILITY TYPE:	735
ADDRESS:	6446 MEADOWGLADE DR		TELEPHONE:	(805) 530-5301
CITY:	MOORPARK	STATE: CA	ZIP CODE:	93021
CAPACITY: 6		CENSUS: 4	DATE:	01/28/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:30 AM
MET WITH:	Narine Babikian & Shadi Heydari Bateni, Program Director		TIME VISIT/ INSPECTION COMPLETED:	01:45 PM

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Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility today to conduct a required annual inspection. Upon arrival, the LPA met with the Program Director, Shadi Heydari Bateni and Administrator Narine Babikian. Reason for the the visit was stated. At approximately 10:30 a.m., the LPA along with the Program Director toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

Kitchen: The facility does not contain a full kitchen, only a kitchenette. The kitchenette consists of pantry and dry food storage area and a refrigerator. Staff indicated that the facility food for lunch and dinner is stored and prepared off-site. Breakfast is prepared in the kitchenette and snacks are available throughout the day for clients. Water and emergency food supply observed at the facility.

Common Areas: Furniture was observed to be in good condition, and the lighting was adequate. The facility maintained a comfortable temperature. The LPA observed the required postings in the common area. The smoke detector(s) and carbon monoxide detector were operational at the time of the visit. The fire extinguisher was observed to be fully charged on 01/08/2025. There is a functioning telephone on the premises. The LPA observed the fireplace in the living room adequately screened. Last disaster drill was conducted in 01/2025. Personal protective emergency (PPE) supply observed (masks, gloves and sanitizers). Administrator will ensure a 30 day supply of PPE is maintained at the facility.

Restrooms: The three (3) client restrooms observed clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature was measured in at 109 degrees Fahrenheit. Facility has a tankless water heater which is set not to exceed 120 degrees farenheit. (Continue to LIC 809c)

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: MEADOWGLADE, THE	FACILITY NUMBER: 565850066
	VISIT DATE: 01/28/2025

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Bedrooms: There are four (4) client bedrooms (two double and two private). All bedrooms were furnished with appropriate linens and required furniture. Adequate lighting in all bedrooms was observed.

Records: The LPA reviewed client and staff records from approximately 12 p.m.-1pm. Client files reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, and current needs and services plan.

Staff files reviewed for, but not limited to, the following: personnel records, health screening, criminal record statements, and current first aid certification and training requirements.

Medications: Medications review conducted at approximately 10:45 a.m.; medications are centrally stored and locked. All medications including PRNs were labeled, stored, and locked inaccessible to clients. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during medications review.

No deficiencies were noted at this time. Exit interview conducted. Report was reviewed and a copy was issued

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC809 (FAS) - (06/04)

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