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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850273
Report Date: 10/24/2024
Date Signed: 10/24/2024 02:46:11 PM


Document Has Been Signed on 10/24/2024 02:46 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:NAVITA RESIDENCES YOUNGFACILITY NUMBER:
565850273
ADMINISTRATOR:VIJAYAKUMAR, KARTHIGAFACILITY TYPE:
740
ADDRESS:2024 YOUNG AVETELEPHONE:
(805) 917-2025
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:6CENSUS: 0DATE:
10/24/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Leo MercaTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Angela Barutyan conducted a case management - other visit with the purpose of following up with the Licensee following the written request to close the facility the Licensee made to the Department on 10/15/2024. LPA arrived at the facility at 1:50PM and met with staff Leo Merca. Entrance interview conducted.

LPA and staff toured the facility at 02:00PM of indoor and outdoor and all facility grounds. LPA did not
observe any residents at the facility at the time of the visit. Staff stated they have been living at the facility until the facility closes. At 01:58PM, LPA spoke with the Administrator Shila Pandey telephonically who stated that the last resident moved out on 10/11/2024 to another licensed facility. LPA did not observe any personal belongings at the facility besides those belonging to the staff.

On 10/15/2024, Licensee informed the Department via email of their intent to close. Based on the LPA's
observations during today's visit, the LPA concluded that all operation of the Residential Care Facility for the
Elderly has ceased.

The Administrator stated that the original License has been disposed of by a moving company. Therefore, LPA was unable to obtain the original and Licensee was not able to surrender the License. LPA obtained a physical copy of the license that was left in the facility, not the original.

Exit interview conducted. A copy of the report was provided.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angela BarutyanTELEPHONE: 747-922-1234
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2024
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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