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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609655
Report Date: 09/24/2024
Date Signed: 09/24/2024 10:59:15 AM


Document Has Been Signed on 09/24/2024 10:59 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:TNA RESIDENTIAL CAREFACILITY NUMBER:
197609655
ADMINISTRATOR:CHRISTINA GABUZYANFACILITY TYPE:
740
ADDRESS:18627 LANARK STREETTELEPHONE:
(818) 593-9292
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 4DATE:
09/24/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mari Akmakchyan, StaffTIME COMPLETED:
11:30 AM
NARRATIVE
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An unannounced Case Management visit was conducted on this day by Licensing Program Analysts (LPAs) Huma Rahimi and Angela Panushkina. The purpose of this visit is to follow up on the Plan of Corrections (POCs) that were issued during an annual visit made on 04/23/2024. Entrance interview conducted with the Staff.

LPA received previously issued deficiencies POCs. However, Section 87202(a)(2) for the Fire Clearance has not been corrected. Although LIC200 had been submitted to the Regional Office the Fire Clearance had not been yet approved. During todays visit, LPAs were informed that multiple connections were made with the Fire Inspector who advised that prior to Fire Clearance an approval from the Building and Safety is required. LPAs were also informed that the process is still on a pending status. Further notification/update will be submitted to LPA promptly. Also during today's visit, LPAs observed all four (4) out of four (4) residents to be Ambulatory.

No deficiency cited during todays visit.

Exit interview conducted and copy of this report signed and delivered.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma RahimiTELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024
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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