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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197610054
Report Date:
01/12/2023
Date Signed:
01/12/2023 11:01:49 AM
Document Has Been Signed on
01/12/2023 11:01 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:
LEO'S ASSISTED LIVING II
FACILITY NUMBER:
197610054
ADMINISTRATOR:
ARAKELIAN, ARMINE
FACILITY TYPE:
740
ADDRESS:
7567 BOVEY AVENUE
TELEPHONE:
(310) 292-2992
CITY:
RESEDA
STATE:
CA
ZIP CODE:
91335
CAPACITY:
6
CENSUS:
2
DATE:
01/12/2023
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
Khatchik Danielian
TIME COMPLETED:
11:00 AM
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At 9:30 a.m. on 01/12/2023 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced Proof of Correction (POC) visit. LPA met with the Administrator and disclosed the reason for the visit.
At 11:14 a.m. on 12/29/2022 the Administrator notified LPA that all deficiencies were cleared. LPA conducted a file review today at 10:00 a.m. and observed complete files for current staff and residents.
LPA cleared deficiencies from 09/28/2022 and 10/27/2022.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Nicholas Reed
TELEPHONE:
(818) 669-8178
LICENSING EVALUATOR SIGNATURE:
DATE:
01/12/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/12/2023
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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