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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600960
Report Date: 01/25/2024
Date Signed: 01/25/2024 04:53:33 PM

Document Has Been Signed on 01/25/2024 04:53 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:AIZABEL HOMEFACILITY NUMBER:
197600960
ADMINISTRATOR:TOLENTINO, MARIA LILIANFACILITY TYPE:
735
ADDRESS:1425 ETHEL ST.TELEPHONE:
(818) 545-3975
CITY:GLENDALESTATE: CAZIP CODE:
91207
CAPACITY: 6CENSUS: 4DATE:
01/25/2024
TYPE OF VISIT:Required - 1 YearMaura PanganibanUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Maura Panganiban, AdministratorTIME COMPLETED:
05:02 PM
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced annual required visit at the facility. LPA Valenzuela met with Administrator Maura Panganiban, The purpose of the visit was discussed.

The facility is licensed for an Adult Residential Facility, capacity of 6 ambulatory clients. Facility is vendorized through San Gabriel Pomona Regional Center as a level 4G home. The facility is a single story, 3 bedroom home; All rooms are shred rooms. Water temperature was measured at 114.0 degrees F, all smoke detectors were operable and fire extinguishers were last serviced in May of 2023. A comfortable temperature of 76 degrees F. is maintained in the facility. There are no bodies of water, and LPA did not observe any accessible hazards.

LPA observed the kitchen to be clean and sanitary, and an adequate supply of perishable and non-perishable foods to be properly stored on site. Client rooms and bathrooms were adequately lit and furnished, all appeared to be sanitary and well-kept. All indoor and outdoor passageways were free of obstruction, and an adequate supply of spare linens and hygienic supplies is present.

There three complete first aid kits. Medication is stored in a cabinet by the kitchen, which is kept locked and inaccessible to clients. Sharp objects and hazardous chemicals are kept locked inside kitchen cabinets and are inaccessible to clients in care.

No deficiencies noted. Exit interview conducted. Signature obtained .
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2024
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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