197609522-7-24-2024-31-AS-LDLC-D7H3TM-20240724183208

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609522
Report Date: 07/24/2024
Date Signed: 07/24/2024 06:33:01 PM

Document Has Been Signed on 07/24/2024 06:33 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	MERIDIAN ELDERLY ASSISTED LIVING		FACILITY NUMBER:	197609522
ADMINISTRATOR:	TAN, C SAMUEL		FACILITY TYPE:	740
ADDRESS:	11343 SATICOY STREET		TELEPHONE:	(818) 308-7553
CITY:	SUN VALLEY	STATE: CA	ZIP CODE:	91352
CAPACITY:	6	CENSUS: 6	DATE:	07/24/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Administrator, Mary Maro Karibian		TIME COMPLETED:	04:00 PM

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Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced required 1-yr inspection. LPA was allowed entry by Turlybek Sadibekov, caregiver at 11:00am and explained the purpose of the visit. At 11:45am, Maro Mary Karibian, Administrator/Licensee and Rima Abelian, designated back up Administrator arrived, LPA explained the purpose of the visit. LPA reviewed resident files, staff files and conducted a tour of the facility between 12:00pm to 3:00pm.

Outside: LPA toured the outside area. LPA observed a shaded sitting area for residents. There is a ramp access with sturdy hand railings. There is a locked detached garage. The detached garage is used as a storage room, used for storing supplies such laundry detergents, toiletries, PPE supplies, incontinence supplies and wheelchairs. The facility does not have any bodies of water.

Common Area: LPA observed all furniture to be clean and in good repair. The facility maintains a comfortable temperature at 77 degrees Fahrenheit. The air conditioner is operational. The facility smoke alarm system is hard wired and interconnected. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. Sprinkler systems are hardwired and interconnected. At 3:00pm they were tested and deemed operational. Facility maintains a telephone land line and it was observed to be operational. Required postings were observed in the hallway. The are 2 fire extinguishers, on in the dining area and the other in the hallway, with inspection date of 11/13/2023.

Food Service and Kitchen Area: The kitchen appliances were functional. The kitchen has a working stove, faucet, refrigerator, and microwave. LPA found enough food for at least three (3) days perishable and seven (7) days non-perishable which are properly stored. Knives were stored in a locked drawer in the kitchen. Food preparation areas are clean. Garbage can have a tight fitting cover. Kitchen cleaning supplies were stored in a locked cabinet. Residents' dining table accommodates six (6) people.

Continued to LIC809-C

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Leizl De La Cerra	TELEPHONE: (818) 454-0632
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024

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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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: MERIDIAN ELDERLY ASSISTED LIVING	FACILITY NUMBER: 197609522
	VISIT DATE: 07/24/2024

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Personnel Records/Staffing: LPA Reviewed files for five (5) staff members. Files are maintained at the facility in a locked room. Proof of staff training, health clearance, vaccinations and 1st Aid/CPR training are current. Staff employed all have criminal background clearance, fingerprint cleared and associated to the facility.
Residents Records: LPA reviewed files for six (06) out of six (06) residents. Files are maintained at the facility in a locked room. Physician's Report (including TB and Ambulatory Status), Consent For Medical Treatment, and Admission agreements, Medical/Functional assessments, Needs and Services Plans, Personal rights. Medications were reviewed for two (02) residents to confirm medication is given as prescribed and is documented properly. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are administered as prescribed by the Physician. Medications are bubbled packed. Medications are in a locked room.
Bedrooms: LPA observed all four (04) bedrooms to be properly furnished with appropriate dresser, night stand, chair, beddings, and linens with sufficient lighting. Extra linens and beddings are stored in the hallway closet. Bedroom #1 is occupied and shared by two (2) residents. Bedroom #2 is occupied and shared by two (2) residents. Bedroom #4 is occupied by one (1) resident. Bedroom #3 is occupied and shared by two (2) residents.
Bathrooms: LPA observed three (03) bathrooms at the facility, two (02) are for residents to use and one (01) is for staff use only which is kept locked. Resident bathrooms have hand washing signs, soap and paper towels. Proper grab bars and non-slip bath mats. The water temperature is 112.3 degrees Fahrenheit and 111.5 degrees Fahrenheit.
Operational Requirements: Liability Insurance policy is valid and will expire on 6/13/2025. Surety Bond (Tokio Marine/American Contractors Indemnity Company)is in effect with bond amount of $3,000.00. The fire clearance is approved on 12/15/2017 for (6) non-ambulatory and (6) bedridden clients. Fire drill was last conducted on 5/18/2024. The First Aid Kit is complete and current. Fire inspection completed on 5-18-2024.

No deficiencies cited. An exit interview was conducted, and a copy of this report was provided to both Back-up Administrator, Rima Abelian and Licensee / Administrator, Maro Mary Karibian.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Leizl De La Cerra	TELEPHONE: (818) 454-0632
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024

LIC809 (FAS) - (06/04)

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