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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603977
Report Date: 02/23/2024
Date Signed: 02/23/2024 04:30:10 PM


Document Has Been Signed on 02/23/2024 04:30 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: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:
02/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:27 PM
MET WITH:Rohangiz "Rose" YadidiTIME COMPLETED:
04:45 PM
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Licensing Program Analysts (LPAs) Valeria Conway and Kelly conducted a Case Management - Other, with the purpose of reviewing the Decision and Order dated 02/15/2024. LPAs explained the reason for the visit.

LPAs met with the Administrator outside the facility as the Administrator stated they did not want staff or residents to hear LPAs the reading of the Decision and Order.

The LPAs, alongside the Administrator, reviewed and discussed the contents of the Stipulation and waiver; and order. The LPAs also provided information on how to submit a written notice to each client, each client's responsible party and each client's placement agency.




Exit interview conducted. Signatures obtained. The LPA provided a copy of the report.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria ConwayTELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2024
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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