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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197610096
Report Date:
07/06/2023
Date Signed:
07/06/2023 12:31:09 PM
Document Has Been Signed on
07/06/2023 12:31 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:
HEALTHY LIFE SERVICE FACILITY
FACILITY NUMBER:
197610096
ADMINISTRATOR:
TADEVOSYAN, LUSINE
FACILITY TYPE:
740
ADDRESS:
15921 LIGGETT STREET
TELEPHONE:
(818) 810-5955
CITY:
NORTH HILLS
STATE:
CA
ZIP CODE:
91343
CAPACITY:
6
CENSUS:
5
DATE:
07/06/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:15 PM
MET WITH:
Arusyak Ohanyan - Owner
TIME COMPLETED:
12:40 PM
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On 07/06/2023 Licensing Program Analyst (LPA) Evelin Rios made an unannounced visit to the facility mentioned above to have amended LIC 9099 and LIC9099-C signed for complaint control #31-AS-20221014100314. LPA met with Licensee Arusyak Ohanyan and explained the purpose of the visit. Licensee opted to sign the amended report originally signed by her administrator Armine Dishoyan. Armine Dishoyan is still the current administrator for the facility.
Exit interview conducted. Copy of report provided.
SUPERVISOR'S NAME:
Eva Miller
TELEPHONE:
(818) 596-4373
LICENSING EVALUATOR NAME:
Evelin Rios
TELEPHONE:
424-299-6104
LICENSING EVALUATOR SIGNATURE:
DATE:
07/06/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/06/2023
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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