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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850510
Report Date: 10/04/2024
Date Signed: 10/04/2024 10:26:46 AM

Document Has Been Signed on 10/04/2024 10:26 AM - 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:SAFE HAVEN SENIOR LIVINGFACILITY NUMBER:
195850510
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, CRISTINAFACILITY TYPE:
740
ADDRESS:14417 BURTON STREETTELEPHONE:
(818) 486-8846
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY: 6CENSUS: 0DATE:
10/04/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Cristina HernandezTIME VISIT/
INSPECTION COMPLETED:
10:20 AM
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On 10/04/2024, 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 Applicants Haig Boghosian and Cristina Hernandez. This is a new facility application for a Residential Care Facility for the Elderly (RCFE).

On 09/06/2024, Licensing Program Analyst (LPA) Sandra Urena conducted a Pre-licensing visit at 9:53 a.m. and met with the applicants Haig Boghosian and Cristina Hernandez. This is a new facility application for a Residential Care Facility for the Elderly (RCFE). Fire Clearance was approved on 08/05/2024 for six (6) non-ambulatory residents. At 10:03 a.m., the LPA, and the applicants 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.

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 the applicant. A copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2024
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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