Senior Care Records.

Facility Evaluation Report

Powelson Home IV, Canoga Park11/20/2025Licence 197606438

Capacity4
Census4
Date signed11/20/2025 12:57:15 PM
Name of licensing program analystPerchui Khurshudyan
Name of licensing program managerNichelle Gillyard
The inspector’s account

On 11/20/2025, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct a required Annual Inspection. Upon arrival LPA was greeted by the DSP/Administrator Ruth Ramos, who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. LPA Khurshudyan reviewed the required postings on a wall throughout the facility. The inspection tool was used to complete today's visit.

At 10:35am LPA, with the help of the caregiver, began a physical plant tour of the facility and the following was observed: This is a single-story building with five (5) bedrooms, two (2) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for four (4) ambulatory clients. Facility is operating level 2 clients.

Kitchen: LPA observed a seven-day supply of non-perishable food, and a two-day supply of perishable food properly stored and labeled. No expired food was observed. Facility stores knives and sharps inside the locked kitchen cabinet. Emergency supply of food / water was stored inside the pantry. Food storage and preparation areas are clean and inaccessible to pests. LPA observed one (1) fire extinguisher located in the hallway with a last service dated 7/14/2025. A weekly menu was also available for clients and was posted on the fridge.

Bedrooms: There are five (5) bedrooms in the facility of which four (4) are designated for clients’ private use, and one (1) bedroom for staff use only. LPA observed bedrooms to be properly furnished with beds, linens, night-stands, chairs, drawers, closets, and adequate lighting. All bedrooms appeared organized and clean.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction