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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609609
Report Date: 06/17/2022
Date Signed: 06/17/2022 12:40:38 PM

Document Has Been Signed on 06/17/2022 12:40 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:KDAD INCFACILITY NUMBER:
197609609
ADMINISTRATOR:ADAMYAN, ARMINEFACILITY TYPE:
735
ADDRESS:9500 NATICK AVETELEPHONE:
(818) 326-4433
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 4CENSUS: 4DATE:
06/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Armine AdamyanTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Wendell Smith made an unannounced annual required visit. LPA met with the staff and explained the reason for this visit. Administrator arrived at the facility at 10am.

LPA conducted a walk through of the physical plant of the facility from 10-10:25am. Facility has a total of five (5) bedrooms and two (2) bathrooms. Four (4) bedrooms are designated for client use. Bedroom #1 and 3 are double occupancy and bedroom #2 and 4 are single occupancy bedrooms for client use. Bedroom #5 designated for staff use. All beds have sheets, pillows, and mattress pads. Right now each client is the only one in their bedrooms. Each bedroom is appropriately furnished. There is also an ample supply of linen, towels and toiletries.
Each bathroom is appropriately furnished. Hot water temperature was checked and observed to be 114 degrees F.
LPA checked the kitchen area for the ability to prepare and store food. LPA observed there to be a sufficient amount of perishable and non perishable food. All knives and sharp objects were observed to be locked up and inaccessible. LPA observe a fire extinguisher by the kitchen. Smoke detectors were observed in common areas and in client rooms. All were observed to be working properly. Carbon monoxide detector was observed to be working properly.
North Los Angeles Regional Center conducted there last visit virtually on 11/12/21.
No deficiencies cited during this visit. Exit Interview conducted.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2022
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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