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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609856
Report Date: 07/19/2021
Date Signed: 07/19/2021 05:11:32 PM

Document Has Been Signed on 07/19/2021 05:11 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,
, CA
FACILITY NAME:WESTFIELD SENIOR LIVINGFACILITY NUMBER:
197609856
ADMINISTRATOR:BALASANYAN, MARIAMFACILITY TYPE:
740
ADDRESS:7633 MASON AVETELEPHONE:
(818) 384-1134
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY: 6CENSUS: 5DATE:
07/19/2021
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Alina Abraamyan TIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Ashley Smith conducted an unannounced Collateral inspection at the facility today at 2:00PM. The LPA spoke with Administrator Mariam Balasanyan over the phone and explained the reason for this visit. The Administrator authorized the staff to sign the report.

Today's inspection is in regards to the investigation of complaint control #29-AS-20200604144340, which is unrelated to this facility. The LPA conducted an interview with a resident relevant to the complaint investigation.

No health and safety concerns were observed during this visit. Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2021
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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