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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610109
Report Date: 01/14/2022
Date Signed: 01/14/2022 12:44:24 PM

Document Has Been Signed on 01/14/2022 12:44 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:INFINITY CARE WITH LOVE, INC.FACILITY NUMBER:
197610109
ADMINISTRATOR:NASHIKYAN, SUSANNAFACILITY TYPE:
740
ADDRESS:16709 SUNBURST ST.TELEPHONE:
(818) 738-5045
CITY:NORTHRIDGESTATE: CAZIP CODE:
91343
CAPACITY: 6CENSUS: 0DATE:
01/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Susanna NashikyanTIME COMPLETED:
12:30 PM
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Licensing Program Analyst conducted an unannounced annual visit on this day.

LPA was met at the door by a family member of the administrator, who stated that the facility was not currently operating. LPA was let into the facility and toured the indoor and outdoor premises, confirming that there are currently three non-client, non-staff residents of the home.

LPA contacted administrator telephonically to read report and confirm the status of the home's inhabitants. Administrator stated that they had not yet obtained criminal record clearances and written lease agreements for the home's inhabitants but agreed to do so as soon as possible.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Alexander Pitz
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2022
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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