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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606094
Report Date: 07/26/2022
Date Signed: 07/26/2022 12:19:00 PM

Document Has Been Signed on 07/26/2022 12:19 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:SHALOM ELDERLY CARE, INC. #2FACILITY NUMBER:
197606094
ADMINISTRATOR:DINA VETCHTEINFACILITY TYPE:
740
ADDRESS:5738 WILHELMINA AVENUETELEPHONE:
(818) 710-8711
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 6CENSUS: 0DATE:
07/26/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Dina Vetchtein and Doris AlmarioTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Elsie Campos conducted an announced Case Management visit today at 10:35 A.M. The LPA informed Licensee Dina Vetchtein of the reason for the visit. Administrator Doris Almario was also present for the visit.

The purpose of this inspection is to document the closure of this facility and ensure all residents have been relocated. The facility closure was initiated by the licensee. The licensee notified Community Care Licensing Division (CCLD) on June 9, 2022, that the licensee intended to close the facility due to downsizing the business. The licensee communicated with families and confirmed that residents would be relocated to other Shalom Elderly Care facilities.

The LPA conducted a physical plant tour at 10:40 a.m. and observed no residents were at this location. It was confirmed that all six (6) residents were relocated. Three (3) residents were relocated to Shalom Elderly Care #4 (197608653), one (1) resident was relocated to Shalom Elderly Care #5 (197608654) and two (2) residents were relocated to Shalom Elderly Care #6 (197608655).

Closure of this facility has been confirmed. The LPA obtained the license during the visit. Exit interview conducted and a copy of the report was emailed to Licensee Dina Vetchtein.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Elsie Campos
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2022
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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