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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609823
Report Date: 10/21/2022
Date Signed: 10/21/2022 10:15:31 AM


Document Has Been Signed on 10/21/2022 10:15 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:ALALIK CARE HOMEFACILITY NUMBER:
197609823
ADMINISTRATOR:ARZUMANYAN, HARUTYUNFACILITY TYPE:
740
ADDRESS:11152 WOODLEY AVETELEPHONE:
(818) 818-1808
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 6DATE:
10/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Harutiyun Arzumanyan/ AdministratorTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in order to conduct an infection control annual. The LPA was greeted by facility staff, had his temperature taken and COVID-19 questions asked before being allowed entry. The LPA informed staff the reason for the visit and the administrator was called and arrived a short while later. The inspection tool was used to conduct the annual.

The home consists of 6 bedrooms and 4 bathrooms plus a facility office. The smoke alarms and carbon monoxide detectors were tested and functioned properly. The automatic fire doors were also observed to function properly. A functional fire extinguisher was also observed.

The facility is currently following their infection control protocol and no deficiencies were observed during the visit.

Exit interview conducted and report issued.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2022
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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