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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608611
Report Date: 07/30/2024
Date Signed: 07/30/2024 03:26:40 PM


Document Has Been Signed on 07/30/2024 03:26 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:ESTAR RESIDENTIAL CAREFACILITY NUMBER:
197608611
ADMINISTRATOR:ARNALDO A. HUKOMFACILITY TYPE:
740
ADDRESS:8559 BOTHWELL ROADTELEPHONE:
(818) 727-1953
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:6CENSUS: 2DATE:
07/30/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:ARNALDO HUKOM- AdministratorTIME COMPLETED:
03:30 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
An Informal Conference was conducted today in the Woodland Hills Adult and Senior Care Regional office. The purpose of this Informal Conference is to discuss the incident that occurred during the month of March, 2024.

Present at today's meeting are the following:
· Eva Miller, Licensing Program Manager (LPM)
· Mariana Agban, Licensing Program Analyst (LPA)
· Arnaldo Hukom and Esperanza Hukom – Administrators
· Salvacion Butler- Licensee

The informal conference process was explained to the Licensee. The Licensee was also informed that this Informal Conference is a part of the administrative action process. Further citations may result in a Non-Compliance Conference, which could lead to a referral to the Department's Legal Division for possible license revocation or other administrative actions.

BRIEF HISTORY: The facility has been in operation since licensure on 11/06/2014 and is licensed for six non-ambulatory residents, one of which may be bedridden.

A complaint was received by CCL on 3/5/24 alleging that the Licensee did not notify CCL of a sale of the facility. Licensing Program Analyst (LPA) Mariana Agban initiated a complaint investigation on 03/14/2024, with Substantiated findings. During the course of the investigation, Administrator stated that they are currently the facility Administrator until the new applicant applies for the License. The new applicant confirmed that they haven't applied for a License and bought the facility on February 9, 2024. The administrator admitted that they had failed to notify the resident's responsible party in writing and CCL regarding the sale of the facility.


(Continue on 809C)
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana AgbanTELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ESTAR RESIDENTIAL CARE
FACILITY NUMBER: 197608611
VISIT DATE: 07/30/2024
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
26
27
28
29
30
31
32
During today's meeting, LPM Miller discussed and expressed concerns regarding the sale of the property without notifying CCL and to each resident or their responsible persons of the licensee’s intent to sell the facility at least 60 days prior to the transfer of property or business. LPM Miller also expressed concerns that the prospective buyer shall, submit an application for a license within five days of the acceptance of the offer by the seller as specified in Health & Safety Code, Section 1520.

The Licensee was informed that Community Care Licensing (CCL) shall continue to frequently monitor the facility as often as necessary to ensure the Licensee's compliance with Title 22 Regulations



Exit interview conducted, and a copy of the report was given.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana AgbanTELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2