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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609295
Report Date: 04/07/2021
Date Signed: 04/07/2021 05:16:35 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:SERENITY HOME RCFEFACILITY NUMBER:
197609295
ADMINISTRATOR:MANUKYAN, LILITFACILITY TYPE:
740
ADDRESS:8673 CANTERBURY AVENUETELEPHONE:
(818) 414-8887
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:6CENSUS: 0DATE:
04/07/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Lilit ManukyanTIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Eva Miller conducted a Case Management Visit in reference to the closure of "Serenity Home RCFE - 197609295" initiated by the licensee. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s visit was conducted virtually with the use of "FaceTime" with Administrator/Licensee Lilit Manukyan.

The purpose of the visit was to ensure that there are no Residents in Care and that all RCFE Operation has ceased. The Licensee has changed the use of the facility site and it is currently a rental property with tenants in residence. The Licensee obtained permission from the tenants to enter the dwelling for a visit by Community Care Licensing (CCL).

A tour of the physical plant was conducted (virtually). LPA observed no evidence of the provision of care and supervision to dependent adults or elders. The Licensee has surrendered the License and the Facility will be closed in the Licensing Information System as of this date.

A copy of the licensing report was provided for signature and return.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Eva MillerTELEPHONE: (818) 326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021
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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