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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609093
Report Date: 12/22/2021
Date Signed: 12/23/2021 09:53:17 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:ASSISTED COMFORT HOME 2FACILITY NUMBER:
197609093
ADMINISTRATOR:KEVLIYAN, MARIAMFACILITY TYPE:
740
ADDRESS:6909 FALLBROOK AVETELEPHONE:
(818) 800-9970
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:6CENSUS: 0DATE:
12/22/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mariam KevliyanTIME COMPLETED:
09:40 AM
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Licensing Program Analyst (LPA) Yelena Avetisyan conducted a Case Management visit to confirm the closure of this facility.

On 9/13/2021 the licensee/administrator submitted a notice of closure for this facility. The notice at indicated that the facility has not had any residents in care since 8/14/2021. The reason for the closure was due to financial hardship related to the COVID-19 Pandemic.

At attempted visit was conducted at the facility on 12/21/2021, however licensee/administrator was not available to come to the facility. A follow up visit was scheduled for today.

During the virtual visit LPA was given a tour of the facility. The facility was vacant, did not have any furnishings and was currently under construction.

Closure of this facility has been confirmed during todays visit. LPA will submit the file for closure upon returning to the Woodland Hills South Regional office. Ms. Allan was reminded that she is not to admit/retain any residents at the home who require care and supervision.

Licensee provided the LPA the original facility license issued by the Department.

Exit interview conducted and copy of report emailed.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Yelena AvetisyanTELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
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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