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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197610471
Report Date:
05/21/2024
Date Signed:
10/04/2024 09:17:59 AM
Document Has Been Signed on
10/04/2024 09:17 AM
- 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.ASC
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BOARD AND CARE AYC
FACILITY NUMBER:
197610471
ADMINISTRATOR/
DIRECTOR:
OHANYAN, ANAHIT
FACILITY TYPE:
740
ADDRESS:
14950 POLK STREET
TELEPHONE:
(562) 600-0606
CITY:
SYLMAR
STATE:
CA
ZIP CODE:
91342
CAPACITY:
6
CENSUS:
5
DATE:
05/21/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
08:37 AM
MET WITH:
Knarik Babayan - Administrator
TIME VISIT/
INSPECTION COMPLETED:
11:23 AM
NARRATIVE
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Licensing Program Analyst (LPA) Tan conducted an unannounced case management visit for a supposed complaint visit written against the facility. LPA found out in the middle of the visit that the complaint was written on the wrong facility and the complaint was deleted.
LPA conducted physical plant tour at 9:02 AM and observed that the facility is clean and in proper order. LPA interviewed residents and revealed that the staff are good and respectful.
There is no health and safety issue during this visit.
Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME
:
Troy Agard
LICENSING EVALUATOR NAME
:
Jose Gary Tan
LICENSING EVALUATOR SIGNATURE
:
DATE:
05/21/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/21/2024
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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