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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610248
Report Date: 09/07/2023
Date Signed: 09/07/2023 03:56:06 PM


Document Has Been Signed on 09/07/2023 03:56 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:VELVET CAREFACILITY NUMBER:
197610248
ADMINISTRATOR:PAROYAN, NAIRAFACILITY TYPE:
740
ADDRESS:15731 LEMARSH ST.TELEPHONE:
(818) 810-0074
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 6DATE:
09/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Naira ParoyanTIME COMPLETED:
03:55 PM
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At 2:50 p.m. on 09/07/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with staff and later Administrator and disclosed the reason for the visit.

Today’s case management visit is conducted to inspect facility plumbing issues and provide guidance on eviction issues with Resident #1 (R1).

LPA interviewed Staff #1 (S1) at 3:10 p.m., the Administrator at 3:20 p.m, Resident #2 (R2) at 3:40 p.m. and toured the facility today inside and out at 3:45 p.m. LPA observed hazardous water leakage from the toilet in the main restroom at 3:45 p.m. today. Administrator to send updated Emergency Disaster Plan to LPA on 09/08/2023 to address the facility plumbing issue.

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: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2023
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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