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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609655
Report Date: 06/21/2023
Date Signed: 06/21/2023 03:03:39 PM


Document Has Been Signed on 06/21/2023 03:03 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:TNA RESIDENTIAL CAREFACILITY NUMBER:
197609655
ADMINISTRATOR:AKMAKCHYAN, MARIFACILITY TYPE:
740
ADDRESS:18627 LANARK STREETTELEPHONE:
(818) 593-9292
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: DATE:
06/21/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Mari Akmakchyan, Administrator TIME COMPLETED:
03:00 PM
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The purpose of this meeting was to discuss a recent information that Regional Office (RO) received on 06/20/23. Present at today’s meeting: Administrator, Mari Akmakchyan; Regional Manager (RM), Angela Kendrick; Licensing Program Manager (LPM), Nichelle Gillyard and Licensing Program Analyst (LPA) Angela Panushkina.
The informal conference process was explained to the Licensee and Administrator. Additionally, they were also informed that this Informal Conference is part of the administrative action process and that further non-compliance and/or citations would result in requiring the attendance at a Non-Compliance Conference meeting.
TNA Residential Care was licensed on 03/01/2019 and currently the facility has three (3) residents. Administrator confirmed that since January 2023 no monthly rent payment was made to the landlord. The total for the six (6) months payment is $30,000.00 and the Administrator informed the Regional Office that new Lease Agreement will be signed, no later than 06/22/23. The following will be conducted before the agreement signed:
I. Walk through.
II. Liability Insurance.
III. New Lease Agreement.
Administrator will inform the Department, immediately, of any changes regarding this transaction.

During today’s conference, the following matters were also discussed:
· New Administrator information needs to be submitted by 06/22/23.
· Compliance plan training from the vendor August 2022.
· Administrator was informed that a copy of the compliance plan can be provided upon request.
Non-compliance issue discussed for the annual conducted in May 23, 2023, and Administrator assured the Department that moving forward the facility will be in compliance.
Exit interview conducted and copy of this report is signed and delivered.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
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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