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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607697
Report Date: 08/29/2023
Date Signed: 08/29/2023 01:36:37 PM

Document Has Been Signed on 08/29/2023 01:36 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:EASTER SEALS SOUTHERN CALIFORNIA FREDERIC HOMEFACILITY NUMBER:
197607697
ADMINISTRATOR:LOURDES MACATANGAYFACILITY TYPE:
735
ADDRESS:2740 N FREDERIC STTELEPHONE:
(818) 843-1716
CITY:BURBANKSTATE: CAZIP CODE:
91504
CAPACITY: 3CENSUS: 3DATE:
08/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Lourdes Macatangay and Remedios Fajardo TIME COMPLETED:
12:45 PM
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Licensing Program Manager (LPM) Naira Margaryan and Licensing Program Analyst (LPA) Antonia Alvizar conducted an unannounced Case Management visit to the facility. The purpose of today’s visit was to serve the Order of Immediate Exclusion from Facility for Staff #1 (S1) and Staff #2 (S2). Prior to this visit Community Care Licensing Department (CCLD) conducted an investigation and it was determined that S1 and S2 violated California Code of Regulations Title 22 for personal rights
On today's visit LPM and LPA met with Administrator, Lourdes Macatangay and District Manager, Remedios Fajardo and explained the reason for the visit. Administrator was served an Immediate Exclusion Order for Staff #1 (S1) and Staff #2 (S2). The Administrator informed LPM and LPA that S1 is not on the shift until tomorrow from 4:00PM to 12 Midnight. Administrator will call S1 and let him know not to show up to work because of letter received from Community Care Licensing. Administrator indicated that S2 is on call for an emergency purpose only.
LPM and LPA met S2 at the EASTER SEALS SOUTHERN CALIFORNIA VALLEY HOME and served letter of exclusions for both facilities; EASTER SEALS SOUTHERN CALIFORNIA VALLEY HOME and EASTER SEALS SOUTHERN CALIFORNIA FREDERIC HOME.
During Todays Visit LPM and LPA noted that S2 is the spouse of the facility Administrator.
The Administrator and District Manager explained that although S2 was associated to this facility, they did not work for the facility since January 2023. .
At the time of visit, S1 was not present at the facility. LPM and LPA will served an Immediate Exclusion letters to S1 via- certified mail to their current address provided by District Manager.
At the time of this visit LPM and LPA served the ORDER OF EXCLUSION of S1 and S2 to the Administrator and District Manager The Government Code 11522 was attached to the exclusion order.
Administrator and District Manager verbalized to LPM and LPA that S1 will not be present to the facility after receiving an Exclusion Order.

No immediate Health and Safety Hazard was noted during this visit,


Exit interview held. A copy of the report was provided to the Administrator and District Manager.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2023
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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