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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197609793
Report Date:
08/17/2021
Date Signed:
01/27/2023 01:44:26 PM
Unsubstantiated
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
21731 VENTURA BLVD. #250
WOODLAND HILLS
,
CA
91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/29/2020
and conducted by Evaluator
Brian Balisi
COMPLAINT CONTROL NUMBER:
29-AS-20201229145543
FACILITY NAME:
SAINT CLAIR ASSISTED LIVING
FACILITY NUMBER:
197609793
ADMINISTRATOR:
ANI MKRTCHYAN
FACILITY TYPE:
740
ADDRESS:
6608 SAINT CLAIR AVE
TELEPHONE:
(323) 793-8228
CITY:
NORTH HOLLYWOOD
STATE:
CA
ZIP CODE:
91606
CAPACITY:
6
CENSUS:
5
DATE:
08/17/2021
UNANNOUNCED
TIME BEGAN:
02:00 PM
MET WITH:
Ani Gabrielian - Administrator
TIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
**This report was amended to include additional information for the report issued on 08/17/2021 the new report will be issued on 1/27/2023**
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Desaree Perera
TELEPHONE:
(818) 596-4347
LICENSING EVALUATOR NAME:
Brian Balisi
TELEPHONE:
(818) 421-9171
LICENSING EVALUATOR SIGNATURE:
DATE:
08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099
(FAS) - (06/04)
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