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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191222261
Report Date: 01/09/2024
Date Signed: 01/09/2024 11:59:01 AM


Document Has Been Signed on 01/09/2024 11:59 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:TRUDEZ HOME CAREFACILITY NUMBER:
191222261
ADMINISTRATOR:LOPEZ, WALDITRUDEZ P.FACILITY TYPE:
740
ADDRESS:15516 EL CAJON ST.TELEPHONE:
(818) 336-6537
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:6CENSUS: 4DATE:
01/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Flora Calderson - StaffTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced case management visit at this facility to follow up on the exclusion of one the staff of the facility.

A Decision and Order regarding Staff #1 (S1)'s immediate exclusion from the facility was effective 12/28/23

During today’s visit LPA read and reviewed the Decision and Order with the Administrator and verified that the administrator has received a copy of the order and staff are aware that S1 is no longer allowed to visit this and any of their facility. LPA interviewed both staff at the facility and stated that S1 has never visited the facility since June of last year.

No citations issued during today's visit.



The Administrator was not available today due to prior personal commitment and designated staff Flora Calderon to sign the report.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary TanTELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024
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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