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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610119
Report Date: 01/21/2021
Date Signed: 01/21/2021 11:40:29 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:LEAR ASSISTED LIVINGFACILITY NUMBER:
197610119
ADMINISTRATOR:NERSESYAN, TIGRANFACILITY TYPE:
740
ADDRESS:23463 HAYNES STREETTELEPHONE:
(310) 770-4010
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:6CENSUS: 0DATE:
01/21/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Tigran NersesyanTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Pitz conducted a scheduled prelicensing visit on this day.

Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today's visit was conducted telephonically with Adminsitrator Tigran Nersesyan.

LPA conducted a visual tour of the facility via FaceTime and utilized the RCFE Prelicensing Inspection tool to review all eleven inspection domains, no deficiencies were observed.

A hard copy of the report will be sent to the applicant to be signed and returned via email.

Component III was conducted during the visit.

This report will be sent to the Centralized Application Bureau (CAB) You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB analyst. Failure to comply could affect approval of your license
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Alexander PitzTELEPHONE: (805) 450-1627
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2021
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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