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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610429
Report Date: 07/09/2024
Date Signed: 07/09/2024 03:49:48 PM

Document Has Been Signed on 07/09/2024 03:49 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:SIMPLE TOUCH BOARD AND CARE INCFACILITY NUMBER:
197610429
ADMINISTRATOR/
DIRECTOR:		SARKISYAN, KARINEFACILITY TYPE:
740
ADDRESS:22317 MOBILE STTELEPHONE:
(747) 444-8506
CITY:CANOGA PARKSTATE: CAZIP CODE:
91303
CAPACITY: 6CENSUS: 2DATE:
07/09/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Karine Sarkisyan- AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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An unannounced case management visit was conducted by Licensing Program Analyst (LPA) Leslie Ngo-Castaneda. During the visit, LPA met with staff Gegham Amirkhanyan and briefly toured the facility. Staff contacted administrator Karine Sarkisyan over the telephone arrived at the facility at 3:45PM. The purpose of this visit is to follow up on the Plan of Corrections (POCs) that were issued during an complaint visit made on 5.31.2024 by LPA Leslie Ngo-Castaneda. Administrator e-mailed photos of corrections, however due to the nature of some citations, LPA Ngo-Castaneda visited the facility to check corrections in person. See POCs below:

1. Incident Report: During the complaint visit, administrator stated that one of their resident was taken to ER by paramedics. Administrator sent incident report filled-in incorrectly and incomplete on 6.21.2024. During today's visit, LIC 624 was submitted and filled-in correctly. Plan of Correction cleared.

Exit interview conducted. A copy of the report was issued. Administrator understands that if outstanding POC is not met or extended by that a civil penalty may be issued.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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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