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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608505
Report Date: 01/14/2025
Date Signed: 01/14/2025 02:00:10 PM

Document Has Been Signed on 01/14/2025 02:00 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:GLEN PARK AT GLENDALE - BOYNTON STFACILITY NUMBER:
197608505
ADMINISTRATOR/
DIRECTOR:		PINK, JR, TILLMANFACILITY TYPE:
740
ADDRESS:1250 BOYNTON STTELEPHONE:
(818) 246-9000
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY: 98CENSUS: 65DATE:
01/14/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Susan ParkTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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At approximately 12:00 p.m. on 01/14/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with staff and later the administrator and disclosed the reason for the visit.

Today’s case management visit was conducted to ensure the safety and welfare of evacuees from the Eaton Fire who were relocated temporarily to the facility. LPA interviewed the administrator at 12:15 p.m., toured the facility at 12:30 p.m., and interviewed residents between 12:40 p.m. and 1:00 p.m. Currently, three (03) residents from Casa de Madera (197610118) and six (06) residents from an adult residential facility are present. LPA interviewed seven (07) out of nine (09) relocated residents. All residents were in good condition and felt safe.

No immediate health or safety hazards were observed during today’s visit.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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