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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610124
Report Date: 03/20/2023
Date Signed: 03/20/2023 12:47:23 PM

Document Has Been Signed on 03/20/2023 12:47 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:CONCORDIA RESIDENTIAL CAREFACILITY NUMBER:
197610124
ADMINISTRATOR:YEGEYAN, NAZARFACILITY TYPE:
740
ADDRESS:16706 BLACKHAWK STREETTELEPHONE:
(818) 403-1803
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 6DATE:
03/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Nazar YegeyanTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness, conducted a case management visit, in-conjunction to a previous complaint, control # 31-AS-20221205131242, that was previously investigated and concluded with Unsubstantiated findings. LPA's visit was to gather further information pertaining to the complaint.

From 11am to 1pm, LPA conducted interviews with staff and residents. At this time, no further action is required.

Exit interview and copy of report provided.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2023
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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