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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850262
Report Date: 12/10/2023
Date Signed: 12/10/2023 11:12:17 AM


Document Has Been Signed on 12/10/2023 11:12 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:QUORA CAREFACILITY NUMBER:
195850262
ADMINISTRATOR:GOCHIN, RHODAFACILITY TYPE:
740
ADDRESS:22806 CALIFA STREETTELEPHONE:
(747) 230-8689
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 4DATE:
12/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tsiana Mikia, StaffTIME COMPLETED:
11:16 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Emily Peraldi and Marth Arroyo conducted an unannounced visit for the purpose of checking the health and safety of four (4) residents residing at this location. At 10:00 a.m., the LPAs met with Staff #1 (S1) and explained the reason for the visit. At 10:57 a.m., the LPAs spoke with the Applicant, Pogos Tofalyan over the telephone. The Applicant was not available during the time of the visit and authorized staff to sign the report.

At 10:03 a.m., the LPA gained accesses to the property. At 10:35 a.m., the LPAs conducted a brief physical plant tour. During the time of the visit, there were no new residents observed. During the telephonic conversation with the Applicant, Pogos T at 10:57 a.m., LPA Peraldi spoke with him regarding obtaining more perishable and nonperishable food, facility telephone and staffing plan and schedule.

During a Case Management visit conducted on 12/08/2023, LPAs Peraldi and Chochian issued and read the Notice of Operation in Violation of Law (NOVL) with Applicant. The LPAs also reminded the applicant that no new residents shall be admitted until the facility is licensed and failure to comply could affect approval of his license.

Exit interview conducted. A copy of the report of provided.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2023
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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