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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610352
Report Date: 01/25/2024
Date Signed: 01/25/2024 01:25:53 PM


Document Has Been Signed on 01/25/2024 01:25 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:PEACEFUL CURE ASSISTANT LIVINGFACILITY NUMBER:
197610352
ADMINISTRATOR:SARKISYAN, KARINEFACILITY TYPE:
740
ADDRESS:10728 COZYCROFT AVE.TELEPHONE:
(747) 444-8506
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:6CENSUS: 0DATE:
01/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Karine Sarkisyan, AdministratorTIME COMPLETED:
01:00 PM
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At 11:00am Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced Annual/Required visit. Upon arrival LPA rang the door bell and observed through the windows that the home is vacant. LPA contacted the Administrator and explained the reason for the visit. Administrator arrived shortly after.

LPA was informed that the facility had no residents since it was licensed. LPA was also informed the the house required to have a full plumbing repair and is currently under construction. Once the construction is complete the Administrator will begin to operate the business.

At 11:40am, LPA conducted a physical plant tour with the Administrator and the following was observed:

Entire flooring in the facility was removed due to pipe issues. Backyard and the garage had an extra materials for the remodeling (e.t. doors, counters, cabinets, appliances, etc.)

Administrator was informed to notify Community Care Licensing Division (CCLD) once the first resident is admitted.

No citations issued during this visit. Exit interview conducted. Copy of report signed and delivered.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2024
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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