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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610109
Report Date: 05/01/2023
Date Signed: 05/01/2023 12:38:21 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/01/2023 12:38 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:
05/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Susanna NashikyanTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Tihesha Smith conducted an unannounced Annual visit to this facility. LPA Smith was greeted by male occupant and he revealed facility is not operating and Licensee/Administrator is not present in the facility. LPA contacted the Licensee Susanna Nashikyan administrator at 10:45 am. The Licensee revealed no clients are residing in home only her family. The Licensee also revealed she would like to keep her license especially since she recently paid the renewal for current year: 2023. LPA asked administrator if the lease agreements for occupants have been sent to the Licensing department per instructions given during the annual visit on 01/14/2022 and if not, she will need to provide them today. At 11:04 am, LPA Smith contacted Licensing Program Manager (LPM) Naira Margaryan for consultation.

After consulting with LPM Margaryan, the Licensee was contacted by LPA Smith at 11:15 am. During this phone call LPA Smith informed the Licensee that she will need to come to the facility so a tour can be conducted, provide agreements or information for status of facility and she will need to sign the report. The Licensee revealed she will close the facility and will come sign the report. The Licensee arrived at the facility at 12:15 pm.

LPA conducted a tour at 12:20 pm of the physical plant to ensure there are no health and safety hazards and no clients are currently residing in the home. The only individuals in home are Licensee's family.

Exit interview conducted/Copy of report given.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2023
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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