197609007-9-21-2022-28-AS-ACAN-CJGTD5-20220921143747

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609007
Report Date: 08/19/2022
Date Signed: 09/21/2022 02:38:22 PM

Document Has Been Signed on 09/21/2022 02:38 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	GLENDALE GARDEN CARE HOME		FACILITY NUMBER:	197609007
ADMINISTRATOR:	DEANON, IRENE		FACILITY TYPE:	740
ADDRESS:	405 CHESTER STREET		TELEPHONE:	(818) 640-2912
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91203
CAPACITY:	6	CENSUS: 6	DATE:	08/19/2022
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Licensee: Evangeline Ursua		TIME COMPLETED:	10:30 AM

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	Licensing Program Analyst (LPA) Ashley Calderon and Licensing Program Manager (LPM) Fernando Fierros conducted a virtual office meeting on possible changes of property and met with Licensee Evangeline Ursua to discuss the purpose for todays visit. The following was discussed: Status of Facility: Facility has a census of 6 residents and 2 residents are on hospice. Lease: Ireane Deanon and Evangeline 'Lyn' Ursula both have 50/50 on the lease of property. Irene Deanon was not able to attend this meeting but will be informed on what was discussed in todays meeting by Lyn. Lease expires on either Sept 2022. Licensee will provide to the department a copy of the renewed lease by COB 8/22/22. Control of Property: LPM Fierros notified Lyn on possibility of forfeiting property if they lose Control of Property . Property of Ownership : Landlord of the property Anthony ' Tony ' Franco. Franco discussed with Ursua that he would like to raise the rent and possibly convert the detached garage to ADU to rent to an outside individual. Continue on 809c ....

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GLENDALE GARDEN CARE HOME	FACILITY NUMBER: 197609007
	VISIT DATE: 08/19/2022

NARRATIVE

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Miscellaneous / Options:
Options were provided incase of changes: run unlicensed, find another property that application would be needed to submit to CAB , submit plan of operation, and CAB can expedite. In addition, changes to the property would require a fire inspection. If residents get moved to another facility a notice to the residents and responsible party is needed up to 60 days before relocation is needed. All residents would need to be relocated.

Evaluation Manuel:
Discuss and notified Ursua to review the following that can pertain do to Property Changes / Control of Property:

-Control of Property and Expiration of Lease EM 3-0205
-Owner would like to convert garage into an ADU
-Outside Clearances -EM 3-0133 - City permits for any changes to the facility
-Change of Location process/procedures
-Operating unlicensed EM 1-0050
-Fire Clearance EM 2-1115
-Immediate Civil Penalties
-SB Leno Eviction Procedures , LPA Calderon will provide a copy.
-AB949 Krekorian Resident Transfers, LPA Calderon will provide a copy.
-Title 22 Eviction Procedure Section 87224

Deanon and Ursua are not in agreement in moving froward on changes of the property on their end and will talk to Landlord Franco. A meeting with Licensing to discuss updates will be held via MS Teams on 8/29/22.

An exit interview was conducted with Licensee Evangeline 'Lyn' Ursula and a copy of this report was provided via email for signature.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

LIC809 (FAS) - (06/04)

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