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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603977
Report Date: 06/01/2023
Date Signed: 06/01/2023 12:18:04 PM


Document Has Been Signed on 06/01/2023 12:18 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:EDEN GARDEN "C", INC.FACILITY NUMBER:
197603977
ADMINISTRATOR:YADIDI, ROHANGIZFACILITY TYPE:
740
ADDRESS:23601 CANZONET ST.TELEPHONE:
(818) 348-2308
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 6DATE:
06/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Rohangiz YadidiTIME COMPLETED:
12:20 PM
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Licensing Program Analyst's (LPA) Elsie Campos and Ashley Smith conducted a Case Management - Other visit for the purpose of reviewing the Accusation dated 5/26/2023. The LPA met with Administrator Rohangiz Yadidi and explained the reason for the visit. LPA's met with the Administrator outside the facility as the Administrator stated they did not want staff or residents to hear LPA's review the Accusation.

The LPA's, alongside the Administrator, reviewed and discussed the contents of the Accusation dated 5/26/2023. The LPA also provided information pertaining to Health and Safety Code 1569.38 regarding posting and notification requirements.



Exit interview conducted. Signatures obtained. The LPA provided a copy of the report.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023
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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