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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610318
Report Date: 10/11/2022
Date Signed: 10/11/2022 11:22:44 AM


Document Has Been Signed on 10/11/2022 11:22 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:EMERALD SENIOR CARE,INC.FACILITY NUMBER:
197610318
ADMINISTRATOR:PAPAZYAN, HOVHANNESFACILITY TYPE:
740
ADDRESS:10401 ENCINO AVE.TELEPHONE:
(747) 300-2232
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 4DATE:
10/11/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Hovhannes Papzyan/ AdministratorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) ,Patrick Shanahan, arrived at the facility in order to conduct a change of ownership pre-licensing visit. The LPA was greeted by the facility administrator, Hovhannes Papzyan. The Inspection Tool was used to complete the visit.

LPA was able to tour the home, which was observed to be clean and free to debris. This home is a 5 bedroom, 3 bath home. The smoke alarms and carbon monoxide detectors were tested and functioned properly. A functional fire extinguisher was observed in the kitchen. The facility is currently following their infection control plan and no deficiencies were observed during the visit.

Component III was also 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: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022
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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