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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608066
Report Date: 03/27/2024
Date Signed: 03/29/2024 01:29:12 PM


Document Has Been Signed on 03/29/2024 01:29 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:FAMILY CARE MANORFACILITY NUMBER:
197608066
ADMINISTRATOR:HASMIK SUKIASYANFACILITY TYPE:
740
ADDRESS:14127 TIARA STREETTELEPHONE:
(818) 988-4557
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91401
CAPACITY:6CENSUS: 0DATE:
03/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:28 PM
MET WITH:TIME COMPLETED:
12:29 PM
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Licensing Program Analyst (LPA) Emily Peraldi conducted an attempted annual visit to this facility. Upon arrival, the facility appeared empty, and no one answered the door. The LPA called the Licensee and left messages for a call back.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
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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