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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197605091
Report Date: 06/12/2024
Date Signed: 06/12/2024 02:39:39 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/12/2024 02:39 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:YONG CARE HOMEFACILITY NUMBER:
197605091
ADMINISTRATOR:GARY JOHNSONFACILITY TYPE:
740
ADDRESS:1539 W. AVENUE L-12TELEPHONE:
(661) 916-9351
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:6CENSUS: DATE:
06/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:TIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Spaeth conducted an unannounced visit and was greeted by the Administrator. LPA Spaeth was greeted by the Administrator who stated there are no residents. The last resident passed away September, 2023. Since that time, there has not been any new residents.

LPA viewed the notification the Administrator sent to CCL as of May, 2024 stating the facility was closed.

LPA and the Administrator toured the facility at 1:40 pm and viewed the rooms. LPA viewed the resident rooms and all the rooms were empty..

Exit interview was conducted and a copy of the report was given.
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Melissa SpaethTELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024
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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