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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610697
Report Date: 01/08/2025
Date Signed: 01/08/2025 02:49:57 PM

Document Has Been Signed on 01/08/2025 02:49 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
CCLD Regional Office, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:COMFORT COVE SENIOR LIVINGFACILITY NUMBER:
197610697
ADMINISTRATOR/
DIRECTOR:		YENGIBARYAN, LUIZAFACILITY TYPE:
740
ADDRESS:6856 HESPERIA AVETELEPHONE:
(626) 616-2024
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 6CENSUS: DATE:
01/08/2025
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Luiza Yengibaryan & Vahan AvetisyanTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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Facility Type: RCFE
Application Type: Initial
Capacity: 6
Census (if any clients in care): none
COMP II Participants: Luiza Yengibaryan (A) & Vahan Avetisyan (C)
Interview Method: Telephone interview

On January 8, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained.

During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas:
1. Facility operation: License type, client/resident populations, and program
2. Medications/Activities/Transportation
3. Staffing requirements & Training
4. General Provisions
5. Pre-Licensing Readiness
SUPERVISORS NAME: Julia Kim
LICENSING EVALUATOR NAME: Dianne Ramos
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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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