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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609077
Report Date: 11/29/2022
Date Signed: 11/29/2022 12:50:27 PM

Document Has Been Signed on 11/29/2022 12:50 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ALL ABOARD!FACILITY NUMBER:
197609077
ADMINISTRATOR:AVETISYAN, HEGHINEFACILITY TYPE:
740
ADDRESS:10629 COLLETT AVETELEPHONE:
(818) 934-7146
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 4DATE:
11/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Haykuhi Nersisyan/ StaffTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in order to conduct an infection control annual. LPA was greeted by facility staff and the administrator was notified of the visit over the phone. The administrator was not available to come to the facility and the annual was completed with facility staff. The Annual inspection tool was used to complete the annual.

The home consists of 3 bedrooms and 2 bathrooms. All smoke alarms were tested and functioned properly. The Carbon monoxide detector was also functioning properly. The fire extinguisher was observed in the living area and was functional.

The facility is currently following their infection control plan and no deficiencies were observed during today's visit.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
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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