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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607793
Report Date: 05/26/2021
Date Signed: 05/26/2021 07:04:19 PM

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:COLONIAL HOUSEFACILITY NUMBER:
197607793
ADMINISTRATOR:BENJAMIN M. KARPFACILITY TYPE:
740
ADDRESS:10830 OXNARD STREETTELEPHONE:
(818) 763-8247
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:14CENSUS: 0DATE:
05/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jasmine GalvezTIME COMPLETED:
12:10 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
Licensing Program Analyst (LPA) JoAnn Rosales attempted to conduct an unannounced Required -1 Year inspection at the facility. LPA met with Jasmine Galvez LVN for Vineland Post Acute Skilled Nursing Facility (SNF) who contacted their Administrator Gabriel Daher over the telephone.

LPA Rosales spoke with Administrator Daher at 11:07 am and he stated that Colonial Post Acute LLC took over operations of the SNF and they are leasing both the Assisted Living and SNF buildings. Administrator stated that there have been no residents at the Assisted Living building for the last 2 to 3 years. Administrator stated they are currently using the building to store supplies and conduct staff training. LPA advised Administrator that they will need to submit an application for a license to Community Care Licensing if they decide to operate as an Assisted Living facility.

During today’s visit, LPA toured the facility starting at 11:17 am with SNF staff Thomas Marcelo and observed that there were no residents in care residing at the facility.

No citations issued during today's visit.

Exit interview conducted and report was reviewed with staff Galvez

SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann RosalesTELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2021
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