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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197604027
Report Date: 10/01/2021
Date Signed: 10/01/2021 10:19:58 AM

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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ENCINO RETIREMENT HOME, INC.FACILITY NUMBER:
197604027
ADMINISTRATOR:LEVY, AYALLAFACILITY TYPE:
740
ADDRESS:5010 BALBOA BL.TELEPHONE:
(818) 385-0473
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY:6CENSUS: 0DATE:
10/01/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:TIME COMPLETED:
09:00 AM
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Licensing Program Analyst (LPA), Patrick Shanahan, Arrived at this location in order to conduct a Closure Visit of the Facility.

The LPA had received a call from the operator on 8/31/21, stating that the facility has closed and they no longer have any residents. The operator confirmed that she had sold the home and that she no longer has access to the facility.

LPA arrived at the location to ensure that there were no clients at the home. LPA rang the doorbell but there was no answer. LPA could see into the home and observed that there was no furniture in the home.

LPA was able to speak to the operator, who again confirmed that the facility had closed and that she no longer had access to the home.

The operator was not available to sign this report. Report emailed to the operator.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
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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