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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607123
Report Date: 10/12/2023
Date Signed: 10/12/2023 11:53:22 AM


Document Has Been Signed on 10/12/2023 11:53 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 S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:ENCINO LIVINGFACILITY NUMBER:
197607123
ADMINISTRATOR:O. ALMANY & D. PETRASEKFACILITY TYPE:
740
ADDRESS:16710 MAGNOLIA BLVD.TELEPHONE:
(818) 907-1343
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY:6CENSUS: 5DATE:
10/12/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Acting Administrator, Daniel SagalTIME COMPLETED:
12:00 PM
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At 11:15 a.m. on 10/12/2023, Licensing Program Manager (LPM) Troy Agard and Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced Case Management visit to the facility. LPM and LPA met with administrator Daniel Sagal and disclosed the reason for the visit.

The purpose of today’s visit was to serve the Order of Immediate Exclusion from Facility for Staff #1 (S1).

Administrator was served an Immediate Exclusion Order for Staff #1 (S1). The administrator received permission for an immediate exclusion for S1 from Encino Living. S1 was not present in the facility and was not served with an immediate exclusion letter. An immediate exclusion certified letter was mailed to S1’s home address.

No immediate Health and Safety hazards were noted during this visit.

Exit interview held. A copy of the report was provided.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023
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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