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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197605025
Report Date: 07/22/2021
Date Signed: 07/26/2021 11:58:53 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:OLIVE TREE RESIDENTIAL CAREFACILITY NUMBER:
197605025
ADMINISTRATOR:CLAIRE TOLENTINOFACILITY TYPE:
740
ADDRESS:11539 LEADWELL STREETTELEPHONE:
(818) 764-7321
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 0DATE:
07/22/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Claire TolentinoTIME COMPLETED:
11:45 PM
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Licensing Program Analyst (LPA) Angel Ascencio conducted a case management for facility closure with administrator Claire Tolentino.


On 7/16/2021 LPA spoke with Claire who stated that she has had the facility closed for over a year due to the COVID-19 pandemic. Census has been at zero (0) since 2011, and continues to not have residents at this time. On 7/20/2021 - LPA received an email from Claire that included Non-Operation Plan signed 7/7/20 and another notice dating 6/11/2021. Both notices were sent to 744 P Street, Sacramento, CA 95814. LPA observed no eviction notices as no residents have been living here since Non-Operation.

During today's visit, LPA toured the facility and observed that there were no clients residing in the facility. Licensee submitted the facility license to LPA Angel Ascencio.


Exit interview was conducted with the licensee, and a hard copy was provided via email .
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
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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