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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000400
Report Date: 01/10/2025
Date Signed: 01/10/2025 04:54:37 PM

Document Has Been Signed on 01/10/2025 04:54 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:NAZARETH HOUSEFACILITY NUMBER:
372000400
ADMINISTRATOR/
DIRECTOR:		PETROSYAN, MILENAFACILITY TYPE:
740
ADDRESS:6333 RANCHO MISSION ROADTELEPHONE:
(619) 563-0480
CITY:SAN DIEGOSTATE: CAZIP CODE:
92108
CAPACITY: 145CENSUS: 92DATE:
01/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Director Milena Petrosyan and Director of Facilities Nayana GoonatilakaTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced visit for a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Director of Facilities Nayana Goonatilaka. LPA was then joined by Director Milena Petrosyan.

During today’s visit, LPA toured the facility with Milena Petrosyan and Nayana Goonatilaka, interviewed residents and staff, and reviewed records. No deficiencies were cited during today’s visit. Due to time constraints, a return visit on a subsequent day is needed to complete the annual inspection.

An exit interview was conducted with Milena Petrosyan and Nayana Goonatilaka, and a copy of this report and Licensee Rights (LIC 9058 01/16) were provided to Milena Petrosyan and Nayana Goonatilaka.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Juliana Barfield
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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