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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610282
Report Date: 10/07/2022
Date Signed: 10/10/2023 09:59:52 AM

Document Has Been Signed on 10/10/2023 09:59 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, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:PSYCLARITY HEALTH 2FACILITY NUMBER:
197610282
ADMINISTRATOR:BARSALOU, AARONFACILITY TYPE:
772
ADDRESS:4198 SUNSWEPT DRTELEPHONE:
(818) 305-4147
CITY:STUDIO CITYSTATE: CAZIP CODE:
91604
CAPACITY: 6CENSUS: DATE:
10/07/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
07:24 AM
MET WITH:COMP II Waived by CAB MgtTIME COMPLETED:
07:25 AM
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COMP II Waived by CAB Mgt

COMP II waived by CAB



Applicant and administrator: Aaron Barsalou (Applicant/Administrator) (

Reason: COMP II has been waived since the applicant/administrator had successfully completed the COMP II with analyst Thai Doan on 12/07/2021 for PSYCLARITY HEALTH INC., #195850202.
SUPERVISORS NAME: Julia Kim
LICENSING EVALUATOR NAME: Thai Doan
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2022
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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