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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610162
Report Date: 11/02/2023
Date Signed: 11/02/2023 03:18:40 PM


Document Has Been Signed on 11/02/2023 03:18 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:LOVE & CARE SENIOR LIVING, INC.FACILITY NUMBER:
197610162
ADMINISTRATOR:PASCO, DINAH RFACILITY TYPE:
740
ADDRESS:17710 MARTHA STREETTELEPHONE:
(818) 585-0063
CITY:ENCINOSTATE: CAZIP CODE:
91316
CAPACITY:6CENSUS: 6DATE:
11/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Nat BarronTIME COMPLETED:
03:20 PM
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At approximately 2:45 p.m. on 11/02/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with staff and disclosed the reason for the visit.

LPA interviewed staff #1 (S1) at 3:00 p.m. and another individual at 3:05 p.m.

No immediate health and safety concerns were noted during the time of the visit.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023
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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