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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608595
Report Date: 10/03/2024
Date Signed: 10/03/2024 11:41:45 AM

Document Has Been Signed on 10/03/2024 11:41 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:NEST, THEFACILITY NUMBER:
197608595
ADMINISTRATOR/
DIRECTOR:		MICHELLE WEISMANFACILITY TYPE:
740
ADDRESS:4100 HAYVENHURST AVENUETELEPHONE:
(818) 990-6896
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY: 6CENSUS: 2DATE:
10/03/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Janeth Alfaro, StaffTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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At 10:40 AM, Licensing Program Analysts (LPAs) Huma Rahimi and Angela Panushkina conducted unannounced collateral visit to the facility in conjunction with a complaint control #31-AS-20240923114331.LPAs met with the staff and disclosed the reason for the visit.

The purpose of this collateral visit is to conduct an interview with two (2) residents and staffs for an open complaint investigation (complaint #31-AS-20240923114331). LPAs also obtained copies of pertinent documents relevant to the complaint investigation.

Exit interview conducted and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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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