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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610248
Report Date: 10/09/2024
Date Signed: 10/09/2024 02:33:43 PM

Document Has Been Signed on 10/09/2024 02:33 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:VELVET CAREFACILITY NUMBER:
197610248
ADMINISTRATOR/
DIRECTOR:		PAROYAN, NAIRAFACILITY TYPE:
740
ADDRESS:15731 LEMARSH ST.TELEPHONE:
(818) 810-0074
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 6CENSUS: DATE:
10/09/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:25 PM
MET WITH:Rosario Sandoval- Social WorkerTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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At 12:25 PM, Licensing Program Analysts (LPA) Leslie Ngo-Castaneda conducted unannounced collateral visit to the facility in conjunction with a complaint control #31-AS-20241008114501. LPA met with the staff and disclosed the reason for the visit.

The purpose of this collateral visit is to conduct an interview with one (1) resident and staffs for a complaint visit (#31-AS-20241008114501). LPA also obtained copies of pertinent documents relevant to the complaint investigation.

Exit interview conducted and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
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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