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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850251
Report Date: 11/01/2023
Date Signed: 11/01/2023 10:48:19 AM


Document Has Been Signed on 11/01/2023 10:48 AM - 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:VALLEY SENIOR CARE LIVING, INCFACILITY NUMBER:
195850251
ADMINISTRATOR:DANIELIAN, KHATCHIKFACILITY TYPE:
740
ADDRESS:8140 MATILIJA AVETELEPHONE:
(310) 666-2392
CITY:VAN NUYSSTATE: CAZIP CODE:
91402
CAPACITY:0CENSUS: DATE:
11/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:TIME COMPLETED:
10:37 AM
NARRATIVE
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Licensing Program Analyst (LPA) Emily Peraldi, along with Adult Protective Services (APS) Social Worker Liana Abajyan conducted an unannounced visit to this location for the purpose of checking if the three (3) individuals residing at this location have been relocated per Notice of Operation in Violation of Law (NOVL) issued on 09/06/2023. At 9:43 a.m., the LPA and Social Worker attempted to gain access to the property, however the property appeared to be vacant. During the time of the attempted visit, the LPA attempted to contact the operator Davit Hakobyan via telephone calls and text messages.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023
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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