197608506-1-14-2025-31-AS-NRED-DCWTSN-20250114135926

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608506
Report Date: 01/14/2025
Date Signed: 01/14/2025 01:59:31 PM

Document Has Been Signed on 01/14/2025 01:59 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 - MARIPOSA ST		FACILITY NUMBER:	197608506
ADMINISTRATOR/ DIRECTOR:	SUSAN PARK		FACILITY TYPE:	740
ADDRESS:	1220 S MARIPOSA ST		TELEPHONE:	(818) 242-9000
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY: 120	TOTAL ENROLLED CHILDREN: 0	CENSUS: 89	DATE:	01/14/2025
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:30 AM
MET WITH:	Susan Park		TIME VISIT/ INSPECTION COMPLETED:	01:30 PM

NARRATIVE

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At approximately 10:30 a.m. on 01/14/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with staff and later the assistant 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 toured the facility at 10:45 a.m. and interviewed the assistant administrator at 11:00 a.m. Interview with the assistant administrator revealed the facility admitted twenty-two (22) residents on 01/08/25, and all residents left as of 01/12/25. As of today, no residents from other facilities still reside at this facility.

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

Exit interview conducted. Copy of report provided.

Naira Margaryan	TELEPHONE: (818) 596-4368
Nicholas Reed	TELEPHONE: (818) 669-8178
	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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