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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609496
Report Date: 01/17/2025
Date Signed: 01/17/2025 03:51:39 PM

Document Has Been Signed on 01/17/2025 03:51 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 S.RO, 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: 24DATE:
01/17/2025
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:59 AM
MET WITH:Vice President of Operations (VPO), Joel SchochetTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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At approximately 11:55 a.m. on 01/17/2025 Licensing Program Analyst (LPA) Antonia Alvizar-Etitma conducted an unannounced case management visit. LPA met with VPO and disclosed the reason for the visit.

Today’s case management visit was conducted to ensure the safety and welfare of evacuees from the RCFE North Like Villas (LIC# 197603823), due to Eaton Fire. LPA interviewed the Vice President of Operations and staff at about 12:05 p.m., and toured the facility. LPA was not able to conduct interviews, due to Residents’ having lunch. Currently, twenty-four (24) residents from North Lake Villas Inc. # 197603823 facility are present. LPA observed all residents in good condition; well kept, clean and groomed.

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

Exit interview conducted. Copy of report provided.

Naira MargaryanTELEPHONE: (818) 596-4368
Antonia Alvizar-EttimaTELEPHONE: (818) 383-6108
DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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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