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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610006
Report Date: 07/26/2023
Date Signed: 07/26/2023 01:40:09 PM


Document Has Been Signed on 07/26/2023 01:40 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:NORTHRIDGE VILLA FOR ELDERLY, INC.FACILITY NUMBER:
197610006
ADMINISTRATOR:WIJERATHNA, RONIKAFACILITY TYPE:
740
ADDRESS:8419 YOLANDA AVENUETELEPHONE:
(818) 812-9599
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:6CENSUS: 0DATE:
07/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:WIJERATHNA, RONIKA- Via PhoneTIME COMPLETED:
02:00 PM
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On 7/26/23 Licensing Program Analyst (LPA) Mariana Agban conducted a Case Management visit to confirm the closure of this facility.

On 06/21/2023 the licensee/administrator submitted a notice of closure for this facility. The notice indicated that the facility has begun relocating residents beginning in June 2023. The reason for the closure was due to the medical condition of a family member and the job relocation of the licensee/administrator spouse.



On today's visit, LPA attempted to conduct a final walk-through at the facility, however, the licensee/administrator was not available to come to the facility. LPA observed that the facility was vacant through the windows, did not have any furnishings, and currently is for sale according to the sign on the front porch of the facility.

LPA advised the licensee/administrator to submit the original facility license to the Woodland Hills South Regional office.

Exit interview conducted via phone and copy of report emailed and will be signed.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana AgbanTELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023
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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