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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608941
Report Date: 01/18/2023
Date Signed: 01/18/2023 10:16:05 AM


Document Has Been Signed on 01/18/2023 10:16 AM - It Cannot Be Edited

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:NATURAL LIFE ASSISTED LIVINGFACILITY NUMBER:
197608941
ADMINISTRATOR:TANNER, SHANNONFACILITY TYPE:
740
ADDRESS:5933 KENTLAND AVENUETELEPHONE:
(818) 346-3491
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 0DATE:
01/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Stuart BrantleyTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Elsie Campos conducted an announced Case Management visit today at 9:30 A.M. The LPA informed Licensee Shannon Tanner of the reason for the visit. Designated Licensee Representative Stuart Brantley was present for the visit.

The purpose of this inspection is to document the closure of this facility and ensure all residents have been relocated. The facility closure was initiated by the licensee. The licensee notified Community Care Licensing Division (CCLD) on September 8, 2022, that the licensee intended to close the facility due to low admissions. The licensee communicated with families and confirmed that residents would be relocated to Haven Homes (197610327).

The LPA conducted a physical plant tour at 9:40 a.m. and observed no residents were at this location. It was confirmed that (1) one resident was relocated. This was facility had only (1) resident in care. COVID impacted admission which resulted in the facility making the decision to close.

Closure of this facility has been confirmed. The LPA obtained the license during the visit. Exit interview conducted and a copy of the report was emailed to Licensee Shannon Tanner.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2023
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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