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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610401
Report Date: 05/25/2024
Date Signed: 05/25/2024 01:24:04 PM

Document Has Been Signed on 05/25/2024 01:24 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:KDAD INC. 2FACILITY NUMBER:
197610401
ADMINISTRATOR/
DIRECTOR:
ADAMYAN, ARMINEFACILITY TYPE:
735
ADDRESS:15033 BROADMOOR STREETTELEPHONE:
(818) 326-4433
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 4CENSUS: 0DATE:
05/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Armine AdamyanTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Tuesday Cabiness attempted to conduct an unannounced annual inspection. LPA rang the door bell, due to the gate being locked and not able to enter the property. The ring camera responded, Administrator Armine Adamyan answered the call. Administrator informed LPA that she currently has no clients and there was no-one at the property. LPA informed Administrator, that a tour still needed to be conducted. LPA observed (5) cars in the driveway, but was informed, no-one was there. Administrator told LPA that she would be at the facility in (30) minutes. LPA waited until Administrator arrived. Administrator arrived at 10:45am.

LPA entered and observed there were no clients at the facility. LPA observed (4) bedrooms, with (1) shared, (2) will be used for private, and (1) for staff. Resident bedrooms were observed to be appropriately furnished. The common areas living room, kitchen, and dining areas were appropriately furnished, and lighting was adequate. The living room has a television and comfortable furniture. Resident and staff records will be stored in a locked cabinet near the kitchen. Medications will be also centrally stored in the same locked cabinet. There are (2 1/2) bathrooms, with soap and towels. The kitchen knives will be in a locked cabinet. The chemicals and cleaning supplies are stored and locked in the laundry closet. Facility appears to be clean and in good repair. Appliances in the kitchen appeared to be functional. There are various sitting areas in the backyard that are shaded. The backyard is fenced and gates were accessible and easy to open. There is no garage. There is a shed that is kept locked outside. On the property there is another dwelling, which is licensed and permitted.

Administrator was informed to contact Licensing and there LPA when the first client is admitted.

Exit interview and copy of report provided.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2024
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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