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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609496
Report Date: 01/16/2025
Date Signed: 01/16/2025 12:41:25 PM

Document Has Been Signed on 01/16/2025 12:41 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 TERRACE SENIOR LIVINGFACILITY NUMBER:
197609496
ADMINISTRATOR/
DIRECTOR:
JANNAT, SHAHRZADFACILITY TYPE:
740
ADDRESS:16025 VENTURA BLVDTELEPHONE:
(818) 986-8466
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY: 85TOTAL ENROLLED CHILDREN: 0CENSUS: 76DATE:
01/16/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:09 AM
MET WITH:Katia ArriagaTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Michael Cava conducted an unannounced Case Management (CM) visit to the facility. LPA met with the Business Office Manager (BOM), Katia Arriage, and advised the BOM of the reason for the visit.

Today’s CM visit was conducted to ensure the safety and welfare of evacuees from the Eaton Fire who were relocated temporarily to this facility. The CM visit composed of interviews with the BOM, the Charge Nurse and Director of Nursing from both Skilled Nursing Facilities (SNF), and random residents that were evacuated to this facility. A physical plant inspections was also made to insure the health and safety of the residents in care. The following information was obtained during the visit:

SNF #1 has one (1) RN, three (3) LVNs, and four (4) CNAs daily, round the clock for 24 hour coverage. They are awaiting instructions from the Department of Health Service for clearance to return back to their SNF. Care and supervision only provided by their staff and not staff from Encino Terrace.

SNF #2 has 6-8 nurses (CNAs & RNs combined) daily, round the clock for 24 hour coverage. Return to the SNF is indefinite for now. Charge nurse is in communication with the health department for instruction. Care and supervision only provided by their staff and not staff from Encino Terrace.



SNF #1 has a census of 12. SNF #2 has a census of 29. Facility has a census of 35. Total in building 76.

All residents were in good condition and feel safe.

No immediate health or safety hazards were observed during today’s visit.

Exit interview conducted. Copy of report provided.

Eva MillerTELEPHONE: (818) 596-4373
Michael CavaTELEPHONE: (818) 389-7921
DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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