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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610394
Report Date: 03/24/2023
Date Signed: 03/24/2023 10:08:17 AM

Document Has Been Signed on 03/24/2023 10:08 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:CANTARA LUXURY LIVINGFACILITY NUMBER:
197610394
ADMINISTRATOR:ASIRYAN, AREVHATFACILITY TYPE:
735
ADDRESS:10509 CANTARA STREETTELEPHONE:
(323) 879-5408
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 4CENSUS: 0DATE:
03/24/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:LICENSEE/ADMINISTRATOR, AREVHAT ASIRYANTIME COMPLETED:
09:30 AM
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Facility Type: ARF
Application Type: Initial
Capacity: 4
Census (if any clients in care): 0
COMP II Participants: Arevhat Asiryan, Licensee/Administrator
Interview Method: Telephone interview


On 3/24/2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During the COMP II, applicant/administrator did not provide sufficient knowledge of the program and/or community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Component II will be rescheduled. Signed LIC 809 with copy of photo ID have been obtained.
SUPERVISORS NAME: Darla Neeley
LICENSING EVALUATOR NAME: Biridiana Cisneros
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2023
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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