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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609656
Report Date: 02/09/2023
Date Signed: 02/09/2023 02:48:26 PM

Document Has Been Signed on 02/09/2023 02:48 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 NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:VAN NOORD MANORFACILITY NUMBER:
197609656
ADMINISTRATOR:MKRTCHIAN, VAHEFACILITY TYPE:
740
ADDRESS:6700 VAN NOORD AVETELEPHONE:
(818) 414-0005
CITY:VALLEY GLENSTATE: CAZIP CODE:
91606
CAPACITY: 6CENSUS: 0DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Vahe Mkrtchian, AdministratorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required annual inspection. The annual inspection was conducted with emphasis on infection control practices and procedures. Upon arrival at the facility, there was no one present. LPA Yee contacted Vahe Mkrtchian, Administrator via phone and was informed that the facility was vacant and there were no residents residing at the home. The residents had been relocated to a sister facility. The Administrator arrived around 1:25pm to conduct the visit. The home is waiting to be vendorized by the regional center. LPA explained the reason for today's visit.

The facility is a single storey home consisting of a living room, dining room, four bedrooms, of which one is used for live-in staff, 2 full bathrooms and a attached garage. Located in the backyard is a swimming pool. The home is fire cleared for 6 non-ambulatory residents, of which 1 can be bedridden and is approved for 6 hospice waiver.
A tour of the facility was conducted together with the Administrator at 2:10pm. Since the facility is vacant and is in the process of making minor repairs such as painting, walls being patched, mattresses being replaced. There is currently no Covid-19 postings or information posted on the walls. Per the Administrator, all Title 22 and Covid-19 requirements will be in place once the facility repairs and vendorization are completed.
Exit interview was conducted with Vahe Mrktchian and a copy of report provided.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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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