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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609926
Report Date: 09/08/2021
Date Signed: 09/08/2021 10:27:18 AM

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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:SUNRISE AT LENNOXFACILITY NUMBER:
197609926
ADMINISTRATOR:GEVDZHYAN, ANI ASHLEYFACILITY TYPE:
740
ADDRESS:5339 LENNOX AVETELEPHONE:
(818) 616-4288
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91401
CAPACITY:6CENSUS: 0DATE:
09/08/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:ANI GEVDZHYANTIME COMPLETED:
10:30 AM
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At 9:50 a.m., Licensing Program Analyst (LPA), Emily Peraldi conducted an announced Case Management Closure visit to the facility with Licensee ANI GEVDZHYAN. LPA and Licensee conducted a final walk-through of the facility.

On 07-28-2021, Licensee notified Regional Office (RO) the surrender of their license and the closure of the facility.

During today’s visit, LPA observed facility to be vacant and verified that no care and supervision was being provided. During the facility tour of both indoor and outdoor space, LPA observed all rooms and living space areas to be empty. Licensee surrendered license to LPA.

LPA Peraldi has confirmed closure of facility.

Exit interview conducted and a copy of the report was emailed.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
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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