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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609736
Report Date: 10/07/2021
Date Signed: 10/07/2021 04:34:51 PM

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:TUJUNGA CANYON BOARD & CAREFACILITY NUMBER:
197609736
ADMINISTRATOR:ANAHIT MARTIKYANFACILITY TYPE:
740
ADDRESS:9522 TUJUNGA CANYON BLVDTELEPHONE:
(818) 335-0787
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:6CENSUS: 0DATE:
10/07/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Aram PetrosianTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Pitz conducted an unannounced complaint visit on this day, and generated this case management report to document the facility's closure.

Upon arriving to the facility at 11:15 am LPA observed a "for sale" sign in the front driveway. An individual who later identified himself as the administrator's husband informed LPA that the facility has been empty since the first week of September. LPA inspected the facility, confirmed there are no residents, and instructed facility representative on how to submit license and finalize the closure process.

Report reviewed, signed and delivered. Exit interview conducted no deficiencies cited.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Alexander PitzTELEPHONE: (805) 450-1627
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
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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