<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197604069
Report Date: 01/05/2024
Date Signed: 01/05/2024 01:02:27 PM


Document Has Been Signed on 01/05/2024 01:02 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:PORTER RANCH ALOHA IIFACILITY NUMBER:
197604069
ADMINISTRATOR:BRUCE R. PARTRIDGEFACILITY TYPE:
740
ADDRESS:20022 VINTAGE STTELEPHONE:
(818) 349-1055
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:6CENSUS: 0DATE:
01/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Bruce PartridgeTIME COMPLETED:
01:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At 12:55 PM, Licensing Program Manager (LPM) Nichelle Gilyard, and Licensing Program Analysts (LPAs) Huma Rahimi and Perschui Khurshydyan, conducted a Case Management visit to confirm the closure of this facility.

During the visit LPM and LPAs were given a tour of the facility. LPM and LPAs confirmed that there were no residents residing in the facility and that operation had ceased. The reason for closure of the facility is retirement. Administrator surrendered the License to LPAs.

LPA Huma will submit the file for closure upon returning to the Woodland Hills South Regional Office. Bruce was reminded that he is not to admit/retain any residents at the home who require care and supervision.

LPA will e-mail the closure survey.

Exit Interview conducted and copy of this report signed and delivered.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma RahimiTELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1