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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608634
Report Date: 07/01/2021
Date Signed: 07/01/2021 09:25:22 AM

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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ALMUNDO'S HOME CAREFACILITY NUMBER:
197608634
ADMINISTRATOR:EXALDO TOPACIOFACILITY TYPE:
740
ADDRESS:44354 LIVELY AVENUETELEPHONE:
(661) 436-0955
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:4CENSUS: 0DATE:
07/01/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marfie TopacioTIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Pitz conducted an unannounced visit on this day in order to confirm that the facility has been closed. The administrator had already notified the department and surrendered their license. On this day LPA was allowed into the home by former Administrator and confirmed that there are no longer any residents in care in the home. LPA observed one family member of the administrator to now be living in the home and was told that there is also one other tenant who is independent.

Report reviewed, signed and delivered.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Alexander PitzTELEPHONE: (805) 450-1627
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021
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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