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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609049
Report Date: 11/29/2023
Date Signed: 11/29/2023 04:49:44 PM


Document Has Been Signed on 11/29/2023 04:49 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:FALLBROOK GLEN OF WEST HILLSFACILITY NUMBER:
197609049
ADMINISTRATOR:STEPHANIE ODENFACILITY TYPE:
740
ADDRESS:6833 FALLBROOK AVETELEPHONE:
(818) 883-4123
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:114CENSUS: 43DATE:
11/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Stephanie OdenTIME COMPLETED:
04:50 PM
NARRATIVE
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At 11:30 a.m. on 11/29/2023, Licensing Program Analyst (LPA) Nicholas Reed, Licensing Program Manager (LPM) Naira Margaryan, and Regional Manager (RM) Angela Kendrick conducted an announced case management. LPA, LPM, and RM met with Executive Director (ED) Stephanie Oden and four (04) other facility representatives. LA City Fire Inspectors Ben Guzman and Linsay Pellegrini also joined, and all individuals toured the facility at 11:30 a.m. today.

The facility tour was conducted to review proposed facility and capacity changes. LA City Fire inspectors provided guidance on fire clearances of rooms. RM and LPM provided regulatory guidance and observed recent modifications of rooms on the first and second floors.

RM, LPM, LPA, ED, and facility representatives discussed recent facility deficiencies at 1:00 p.m. LPA issued clearance letters for past cleared deficiencies. RM and LPM provided further guidance, and ED and representatives discussed future facility actions to take place after the new facility license is obtained.

No immediate health or safety hazards were observed during this visit.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
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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