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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850239
Report Date: 03/04/2025
Date Signed: 03/04/2025 02:40:26 PM

Document Has Been Signed on 03/04/2025 02:40 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:
03/04/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:39 PM
MET WITH:Elba KhachatryanTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Trevor Byrne and Long Term Care Ombudsman (LTCO) Ginger Perini arrived to the facility at 01:39 PM to conduct an unannounced Case Management – Other inspection at the facility today. LPA met with facility Administrator Elba Khachatryan the reason for the visit was explained.

During today’s visit LPA and LTCO conducted a physical plant tour and interviewed four (4) of six (6) residents as one (1) resident asleep and one (1) resident refused interview 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, 03/02/2025 and 03/03/2025. LPA attempted to speak with the Administrator as they previously stated that they would provide a copy of the LIC 500 no later than end of day Monday 03/03/2025. The Administrator refused to speak with LPA and stated that all communications should be conducted through their attorney. LPA informed the Administrator that the Department has requested the facility’s LIC 500 on three (3) separate occasions. LPA informed the Administrator that the Department is requesting this document to confirm adequate staff coverage and to ensure there are staff present 24/7 at the facility. LPA informed the Administrator that failure to provide this document to the Department could affect their Administrator’s certificate.

No deficiencies were observed during today’s inspection. LPA read this report in the presence of the Administrator. Exit interview conducted and copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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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