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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610393
Report Date: 08/01/2024
Date Signed: 08/01/2024 11:59:27 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/01/2024 11:59 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:NEASISFACILITY NUMBER:
197610393
ADMINISTRATOR:GHAZARYAN, ANIFACILITY TYPE:
740
ADDRESS:8523 TERHUNE AVETELEPHONE:
(747) 250-9701
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY:6CENSUS: 3DATE:
08/01/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Gevorg Khaluyan, Licensee/AdministratorTIME COMPLETED:
03:00 PM
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At 2:00pm on 08/01/2024, Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced continuation of the annual inspection, 07/30/2024. LPA was greeted by Maria Duran, caregiver and explained reason for the visit. Due to a technical error with the system during the annual inspection held on 07/30/24 and the LIC809D was not discoverable which resulted to LPA not being able to get a signature on the LIC809D.

Today, LIC809D was recovered and LPA was able to obtain administrator's Gevorg Khaluyan's signature on the LIC809D.

During the visit today the facility was in compliance with Title 22 regulations.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Leizl De La CerraTELEPHONE: (818) 454-0632
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2024
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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