<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608916
Report Date: 07/13/2020
Date Signed: 07/13/2020 12:37:24 PM

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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:BELLAIRE ASSISTED LIVING, INC.FACILITY NUMBER:
197608916
ADMINISTRATOR:ANGELA KHANJYANFACILITY TYPE:
740
ADDRESS:12702 VANOWEN STREETTELEPHONE:
(818) 934-7755
CITY:VALLEY GLENSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 0DATE:
07/13/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Angela KhanjyanTIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Brian Balisi initiated a case management visit for the purpose of ensuring that all clients have vacated the facility. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically at 12:00pm with Angele Khanjyan, the facility administrator.
 
At 12pm LPA conducted telephone interviews with the administrator and a video call which consisted of a review of physical plant. LPA observed that the home has been completely vacated and there are no residents in care. Administrator stated they will be remodeling home and renting it out.

A telephonic exit interview was conducted with Administrator, and a hard copy was provided via email for signature. 
SUPERVISOR'S NAME: Alex EstradaTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Brian BalisiTELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1