<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610393
Report Date: 06/20/2023
Date Signed: 06/20/2023 11:48:25 AM


Document Has Been Signed on 06/20/2023 11:48 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:NEASISFACILITY NUMBER:
197610393
ADMINISTRATOR:GHAZRYAN, ANIFACILITY TYPE:
740
ADDRESS:8523 TERHUNE AVETELEPHONE:
(747) 250-9701
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY:6CENSUS: 0DATE:
06/20/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:ANI GHAZRYANTIME COMPLETED:
11:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) LaQueena Lacy conducted a Pre-licensing virtual visit on 06/20/2023 at 10:35am to address concerns noted during the previous pre-license visit conducted on 06/01/2023 at 10:47am. The facility has two (02) additional units located on the property behind the facility that were not identified on the orginial facility sketch submitted to the Regional Office. One (01) unit was being used as a storage unit storing clothing and personal items from the previous tenant, the second storing the facility owner personal items. LPA observed the unit storing the previous tenant belongings cleaned out and emptied. Per the administrator the owner cleaned out the items and no one will have access to the units except for the owner. The administrator submitted an updated sketch that identified the additional units on the properties and the fence. During the time of the inspection LPA observed a fence placed up between the facility and the additional units and made inaccessible to residents in care. Per the administrator the gate is measured at 5ft 5in. LPA observed the gate with a green tarp across it, and the fence post in the ground which was steady and unable to be moved.

The facility currently is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and you will be notified by the CAB Analyst when your license has been approved.

Exit interview was conducted with Administrator Ani Ghazryan, a copy of this report will be provided to obtain a wet signature and returned to LPA.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena LacyTELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1