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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609542
Report Date: 06/05/2024
Date Signed: 06/05/2024 11:45:49 AM


Document Has Been Signed on 06/05/2024 11:45 AM - 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:BLYTHE STREET ELDERLY CAREFACILITY NUMBER:
197609542
ADMINISTRATOR:OHANYAN, NONAFACILITY TYPE:
740
ADDRESS:13367 BLYTHE STREETTELEPHONE:
(323) 947-7005
CITY:N HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:5CENSUS: 0DATE:
06/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Nona Ohanyan, Administrator via telephone TIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual inspection at 9:40 a.m. The LPA contacted the Administrator, Nona Ohanyan via telephone and left a voicemail for a call back. The LPA spoke with two (2) individuals at the property. The individuals allowed the LPA entrance to the facility. At 10:34 a.m., the LPA along with one of the individuals toured the physical plant areas inside and outside. The facility appeared vacant, and no residents were present at the time of the inspection. At 10:43 a.m., the Administrator called back the LPA, and the LPA explained the reason for the visit. The LPA explained that a tour was conducted and confirmed that no residents are currently residing at this location. The Administrator stated that she would not be able to meet the LPA but provided the LPA with an email to send the report for signature.

The facility has been without residents since May 1, 2023. There currently is an application in process for a Change of Ownership Application (CHOW) since September 20, 2023.

Exit interview conducted. A copy of the report was issued.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2024
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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