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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850317
Report Date: 01/31/2023
Date Signed: 01/31/2023 11:25:07 AM


Document Has Been Signed on 01/31/2023 11:25 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:STARLIGHT FACILITY INC.FACILITY NUMBER:
195850317
ADMINISTRATOR:TADEVOSYAN, NELLIFACILITY TYPE:
740
ADDRESS:7647 TUJUNGA AVE.TELEPHONE:
(818) 378-7069
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 0DATE:
01/31/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nelli TadevosyanTIME COMPLETED:
11:05 AM
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On 01/31/2023, Licensing Program Analyst (LPA), Sandra Urena, conducted a subsequent pre-licensing visit
at 10:00 a.m. The LPA met with the applicant, and conducted a follow up inspection to ensure that deficiencies were corrected prior to license being approved.
The first pre-licensing visit was conducted by Licensing Program Analyst (LPA), Sandra Urena. The LPA arrived at the facility at 09:40 a.m., and met with applicant Nelli Tadevosyan. This is a new facility application for a total of six residents, five (5) non-ambulatory, and one bedridden. Fire Clearance was approved on 11/18/2022 for one bedridden resident, and resident is allowed to reside in bedroom #3.
The following deficiencies were corrected:

During the inspection, the LPA, and applicant observed the following corrections.

1. Door leading to bedrooms is kept open.

2. An operating telephone is available for residents' use.

3. A gate was installed to prevent residents from wondering into the slopped area in the back of outdoor area.


4. The two protruding screws sticking out of the wall were covered, and a gate was installed.
5. A ramp for residents’ use was installed in the kitchen door leading to the backyard to allow access to residents to the outdoor area.
6. Trash cans with a tight-fitting lid were purchased and placed in the kitchen and all bathrooms.
This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst
when your license has been approved. You are not allowed to begin operating until you have been notified
that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your
license.
Exit interview was conducted and reviewed with applicant Nelli Tadevosyan . A copy of the report was
issued
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2023
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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