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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850419
Report Date: 10/02/2024
Date Signed: 10/02/2024 12:03:30 PM

Document Has Been Signed on 10/02/2024 12:03 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:LOVING HOME INCFACILITY NUMBER:
195850419
ADMINISTRATOR/
DIRECTOR:		EDITH MARDOROSSIANSFACILITY TYPE:
740
ADDRESS:15105 BURTON STREETTELEPHONE:
(818) 268-2651
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY: 4CENSUS: 0DATE:
10/02/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Edith MardorossiansTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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On 10/02/2024, Licensing Program Analyst (LPA), Sandra Urena conducted a subsequent pre-licensing visit. The LPA arrived at the facility at 09:30 a.m. and met with Applicant Edith Mardorossians. This is a new facility application for a Residential Facility or the Elderly (RCFE).

On 09/2024, the initial pre-licensing visit was conducted by Licensing Program Analyst (LPA), Sandra Urena. The LPA arrived at the facility and met with Applicant Edith Mardorossians. The LPA, and the applicant toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. This is a new facility application for a Residential Facility or the Elderly (RCFE) four (4) non-ambulatory residents, which one can be a bedridden resident. Fire Clearance was approved on 12/14/2023 for one bedridden resident in bedroom #2. A hospice waiver was granted for four (4) residents.

At 09:45 a.m., the LPA and the Applicant toured the facility to ensure the corrections were completed.


This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.

Exit interview was conducted and reviewed with applicant. A copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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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