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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607123
Report Date: 12/18/2023
Date Signed: 12/18/2023 01:48:20 PM


Document Has Been Signed on 12/18/2023 01:48 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., 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:
12/18/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Daniel SagalTIME COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced POC (Plan of Correction) visit to clear deficiency from COMPLAINT CONTROL NUMBER:31-AS-20230214165012.

LPA Smith met with new administrator, Daniel Sagal. Per administrator former staff present during complaint no longer works at facility. Administrator also informed LPA that current staff have been trained on Medication administration on 10/10/2023 and 10/14/2023. LPA review files and requested copies of training and staff certificates. Deficiency is cleared.

Exit interview conducted/Copy of report issued.

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha SmithTELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023
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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