Van Nuys Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the CARE Inspection Tool and was let into the home by Margarit Babayan, Staff. Sargis Ayvazyan, Administrator was contacted by phone and he arrived at 11:26am to conduct the visit. The reason for today's visit was explained. The facility is a single storey family home consisting of a living room, dining room, kitchen, 4 bedrooms of which one is used for live-in staff, an office, a laundry room, 2 full bathrooms and a attached garage. The facility is fire cleared for 3 NON-AMBULATORY and 3 BEDRIDDEN residents. Bedrooms #1, #2 and #4 are designated for bedridden residents. The home is also equipped with a sprinkler system. The following domains were reviewed on today's visit: Operational Requirements, Personnel Requirements/Staff training, Planned Activities, Incidental and Medical, Resident Records/Incident Report and Residents with Special Health Needs. Also reviewed on today's visit were 4 staff files and 6 resident files. A return visit will have to be conducted to complete the annual inspection. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Any citations not addressed on today's visit will be addressed on a return visit. Exit interview was conducted, Appeals Rights were discussed and a copy was provided.the state’s words, verbatim · CDSS document, Dec 19, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 1:00 p.m. Upon arrival, LPA Mosley was greeted by staff and called the Administrator to inform them of the visit. The Administrator arrived shortly thereafter. The LPA met with SARGIS AYVAZYAN – Administrator and explained the reason for the visit. The LPA 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. The facility is a single-story family home consisting of a living room, dining room, kitchen, 4 bedrooms of which one is used for live-in staff, an office, a laundry room, 2 full bathrooms and an attached garage. The facility is fire cleared for 3 NON-AMBULATORY and 3 BEDRIDDEN residents. Bedrooms #1, #2 and #4 are designated for bedridden residents. The home is also equipped with a sprinkler system. KITCHEN: The LPA inspected the kitchen/food service area at 1:35 p.m. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. Chemical storage is kept locked under the sink. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 117.1 degrees Fahrenheit at 1:42 p.m. (PAGE 1) Report Continued on LIC 809C PAGE 2... (PAGE 2) Report Continued from LIC 809 PAGE 1... COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 3:31 p.m., hardwire combination of smoke / carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 07/11/2024. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 10/24/2024. Activities were observed in the common areas. The fireplace was adequately screened at the time of the visit. Adjacent to the kitchen is a laundry room, with a washer and dryer. RESTROOMS: There are two (2) restrooms designated for resident use. Resident restrooms were observed to be equipped with nonskid surfaces. Grab bars were observed in both bathrooms. The restrooms were sufficiently stocked with supplies and paper towels. The water temperature was measured in both resident restrooms between 117.0-117.1 degrees Fahrenheit all within the required range. BEDROOMS: There are four (4) total bedrooms in the facility. Three (3) bedrooms are designated as shared, double occupancy resident rooms and one (1) staff room. The staff room is kept locked. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. GARAGE/BACKYARD: The garage is maintained locked at all times. LPA observed an adequate amount of emergency food and water. Cleaning supplies are kept in the garage locked and inaccessible to residents in care. The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. There were no bodies of water noted at the time of the visit. Laundry detergent was observed in a locked cabinet in the garage. MEDICATIONS: Medications review began at approximately 3:18 p.m. The medications are in a locked cabinet adjacent to the living room. Medications for three (3) residents were reviewed. Medications reviewed were found to be self administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed at the time of the visit. Report Continued on LIC 809C PAGE 3... (PAGE 3) Report Continued from LIC 809C PAGE 2... RECORDS: Record review began at approx. 1:48 pm. Resident Records: Six (6) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. Three (3) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INTERVIEWS: Interviews began at approx. 3:40pm. Two (2) staff interviews were conducted. Interviews revealed that staff are knowledgeable in resident rights, different forms of abuse and reporting procedures. Three (3) resident interviews were conducted during the inspection. No concerns noted at the time of the visit. No deficiencies were cited during today’s inspection. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 17, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Christine Yee conducted an announced Pre-licensing and Component III visit and met with Sargis Ayvazyan, Applicant and Marine Danielyan, Spouse/Staff. The facility is a single storey family home consisting of a living room, dining room, kitchen, 4 bedrooms of which one is used for live-in staff, a office, a laundry room, 2 full bathrooms and a attached garage. The facility is fire cleared for 3 NON-AMBULATORY and 3 BEDRIDDEN residents. Bedrooms #1, #2 and #4 are designated for bedridden residents. The home is also equipped with a sprinkler system. The following was observed on today's visit: the living room is furnished with a sofa and 2 armchairs. Located in the living room is a fire place. A fire screen was not observed. the dining room has a glass table with 6 chairs the kitchen is equipped with a stove, microwave and 3 refrigerator. Cleaning supplies are stored in a locked cabinet under the kitchen sink. Knives are stored in a locked kitchen drawer. 13 dinner plates, 3 salad plates, 9 bowls, 4 cups, 3 plastic glasses, pots, pans, 6 dinner forks, 6 desert forks, 6 dinner knives, 6 tablespoons and 6 teaspoons were observed. No perishable foods were purchased and additional non-perishable foods for 7days were purchase during the visit. The only fire extinguisher, purchased on 7/17/23 and the carbon monoxide detector are located in the kitchen. 2 first aid kits and a first aid manual were observed in the kitchen. Tweezers, scissors were observed but no thermometer adjacent to the kitchen is the laundry room with a washer and dryer. A linen closet with 18 bath towels, 18 hand towels and 18 face towel and extra fitted sheets were observed. the attached garage can be accessed through the laundry room. The garage needs to be cleaned out due to excessive items stored in the garage resident bedrooms #1, bedroom #2 and bedroom #4 all contain 2 twin beds, 2 night stands, 2 lamps, 1 shared dresser and a built in closet, except bedroom #4 has 2 walk in closets. No chairs were observed. The 3 rooms have doors that lead directly to the outside and were equipped with auditory devices. Ramps were also observed. Window dressings for privacy were observed. bedroom #3 will be used for a live-in staff and was not furnished. the two common bathrooms, one located in the front and one located in the back, are equipped with a open shower, a toilet and a sink. Grab bars were observed. The bathrooms did not have any non-skid mats. A shower chair was observed in the front bathroom. Water temperature was tested and the water in the back bathroom read 123.3 degrees Fahrenheit and the front bathroom read 121.8 degrees Fahrenheit. Thermostat was adjusted during the visit and retested at 4:15pm and it read 105 degrees Fahrenheit Medications will be centrally stored in a locked hallway closet the required posters were observed by the front door all exit doors to the outside are equipped with auditory devices resident and staff files will be stored in the office. 3 shampoo and 8 rolls of toilet paper were observed. Other hygiene products such as bath soap, toothpaste, toothbrushes, combs need to be purchased. the hardwired smoke detectors located in the resident rooms and hallway were tested and were operational cameras were observed in the common areas and in bedroom #3. Per applicant, the cameras are not operational and may be replaced. Applicant was advised to either remove or submit a written addendum to update the facility's plan of operation to indicate where the cameras are installed and how the information will be used and who has access to the information. 6 chairs were observed set up in the front of the facility the front yard, backyard and the sides of house need to be cleaned out and unused/discarded items and furniture need to be thrown out or stored away. The weeds and grass need to be removed/mowed. The hedge needs to be trimmed. the facility has a land line. Telephone # is (747) 225-2070 Applicant will obtain liability insurance in the required limits once the facility is licensed. The following corrections need to be addressed prior to licensure or as noted: a fire screen needs to be placed in front of the fire place a thermometer needs to be purchased for the first aid kit cups and glasses need to be purchased for 6 residents flat sheets, blankets and pillow cases needs to be provided and extra bed linens need to be purchased to allow for changing weekly and as needed. the garage needs to be cleaned out and all excess items due to construction need to be removed chairs for each resident need to be provided in all the resident bedrooms non-skid mats need to be provided in the bathrooms hygiene products and additional toilet paper need to be purchased perishable foods need to be purchased prior to the acceptance of the first resident. Liability insurance meeting Title 22 requirements will be purchased upon licensure the backyard, front yard and sides of the house need to be cleaned and items stored or discarded. a table for activities, chairs and an umbrellas provided for outside activity Applicant will provide evidence of the above corrections once it has been completed. COMPONENT III was conducted on today's visit with Sargis Ayvazyan and Marine Danielyan Exit interview was conducted.the state’s words, verbatim · CDSS document, Oct 31, 2023