Facility Evaluation Report

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an announced Case Management visit to the facility. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Administrator Alice Millan and Caregiver Jerome Osit. The purpose of the visit was to conduct the facility closure as the facility had a change of location to a new address.

LPA had spoken with Licensee Kamran Banayan over the phone 1/8/26, and Licensee Banayan requested for the closure visit to occur today. LPA had conducted a Post-Licensing visit at the new facility location earlier this morning and confirmed the residents were present there.

During today's visit, LPA and Administrator Millan conducted a walk-through of the home and LPA confirmed that there were no residents here. The home was empty and the property fenced off. LPA collected the physical license for the home from Administrator Millan.

No deficiencies were cited during today's inspection. An exit interview was conducted with Administrator Millan to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.