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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191202190
Report Date: 10/07/2020
Date Signed: 10/07/2020 04:44:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:WINDSORFACILITY NUMBER:
191202190
ADMINISTRATOR:CAMERON, LEIF JFACILITY TYPE:
741
ADDRESS:1230 EAST WINDSOR ROADTELEPHONE:
(818) 244-7219
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:175CENSUS: 94DATE:
10/07/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator Yvette DuarteTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Jose Villalobos conducted a case management visit regarding the Health and Safety of the residents in placement at this facility.
Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s visit was conducted telephonically. LPA Villalobos met with Administrator Yvette Duarte.

On today's visit, LPA toured the facility and observed all residents and staff during this visit. The food supply was observed as well. Medications and all toxic cleaning supplies were stored and inaccessible to clients in care. LPA found the facility to be clean and sanitary. LPA observed all requirements per Title 22 to be in compliance. No immediate health and safety concerns were identified, during this visit. A telephonic exit interview was conducted with Administrator Yvette Duarte and a hard copy was provided via email for signature.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020
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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