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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850590
Report Date: 01/27/2025
Date Signed: 01/27/2025 10:13:11 AM

Document Has Been Signed on 01/27/2025 10:13 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:NIRVANA GARDENS ASSISTED LIVINGFACILITY NUMBER:
195850590
ADMINISTRATOR/
DIRECTOR:		GABUZYAN, CHRISTINAFACILITY TYPE:
740
ADDRESS:15801 HART ST.TELEPHONE:
(323) 925-6629
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 6CENSUS: 0DATE:
01/27/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:06 AM
MET WITH:Christina GabuzyanTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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LPA Urena received via email pictures of the corrections for the deficiencies cited on the pre-licensing visit conducted on 01/16/2025.
The following deficiencies have been cleared.
-The applicant will install a ramp with handrails for residents to access the patio area.

-Applicant will add additional chest of drawers to bedrooms 1 and 2. Applicant will add two (2) lamps to bedroom #3.

-Applicant will add handrails to ramp connected to bedroom #3.


-An auditory device will be installed to monitor the gate exit.

-The applicant will have the following items removed or relocated to another area: Bricks, and fencing.


-A gate will be installed on the right-hand side of the building to prevent residents from wondering to this area.
-A small threshold ramp will be installed in the bathroom.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2025
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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