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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850239
Report Date: 03/03/2025
Date Signed: 03/03/2025 02:29:14 PM

Document Has Been Signed on 03/03/2025 02:29 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:SILVER LIGHT CAREFACILITY NUMBER:
195850239
ADMINISTRATOR/
DIRECTOR:		KHACHATRYAN, ELBAFACILITY TYPE:
740
ADDRESS:8201 VANTAGE AVENUETELEPHONE:
(747) 228-4111
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 6CENSUS: 6DATE:
03/03/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Keyna NkumbulaTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 01:50 PM to conduct an unannounced Case Management – Other inspection at the facility today. LPA met with facility staff member Keyna Nkumbula (S1) who contacted the facility Administrator Elba Khachatryan via telephone call entrance interview conducted and the reason for the visit was explained.

During today’s visit LPA conducted a physical plant tour and interviewed five (5) of six (6) residents as one (1) resident was out of the facility at the time of the inspection. No immediate health and safety concerns were observed. All residents interviewed stated that they are fed well, staff were present at the facility all night, and medications were given. No residents interviewed had concerns with the facility at the time of the inspection.

CCLD had previously requested a copy of the facility's LIC 500 on 03/01/2025 and 03/02/2025. On 03/02/2025 the Administrator stated that they would provide a copy of the LIC 500 no later than end of day Monday 03/03/2025. As of the time of the visit the Administrator has still not provided CCLD with a copy of the facility's LIC 500.

No deficiencies were observed during today’s inspection. The Administrator did not respond to phone calls from the LPA at the time the report was delivered. S1 has signed this report on the facility's behalf. Exit interview conducted and copy of the report was issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2025
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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