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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000400
Report Date: 01/14/2025
Date Signed: 01/14/2025 12:59:31 PM

Document Has Been Signed on 01/14/2025 12:59 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
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: 145TOTAL ENROLLED CHILDREN: 0CENSUS: 92DATE:
01/14/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Director of Facilities Nayana Goonatilaka and Executive Director Milena Petrosyan.TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced 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 and Executive Director Milena Petrosyan.

According to the facility’s license, the facility has a maximum capacity of 145 residents, of whom all may be non-ambulatory. During today’s inspection, there were a total of ninety-two (92) clients in care. This facility does not feature a secured perimeter or delayed egress doors.

LPA, accompanied by Milena Petrosyan, toured the interior and exterior of the facility. Pathways were free of obstruction and slip hazards. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities.

Hot water temperature at taps accessible to clients were all compliant.

There was at least 2 days supply of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters observed available to clients. Medications were labeled, as required, and stored in locked areas.



No pools or bodies of water were observed on the premises. Per Milena Petrosyan, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. Confidential records were stored in locked areas. Milena Petrosyan also presented proof of current/active business liability insurance.

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.
Lizzette TellezTELEPHONE: (619) 767-2351
Juliana BarfieldTELEPHONE: (619) 994-7269
DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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