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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609315
Report Date: 12/30/2021
Date Signed: 12/30/2021 03:06:26 PM

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:DE SOTO ELDERLY CARE FACILITY INCFACILITY NUMBER:
197609315
ADMINISTRATOR:SANDRA CARRIEDOFACILITY TYPE:
740
ADDRESS:7820 DE SOTO AVETELEPHONE:
(818) 462-3178
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY:6CENSUS: DATE:
12/30/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Administrator Sandra Carriedo TIME COMPLETED:
03:05 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
At approximately 2:35 PM on 12/30/2021, Licensing Program Analyst (LPA) Nicholas Reed conducted a Case Management visit. LPA met with staff and disclosed the reason for the visit.

The census is 1 resident.

LPA observed proper signage outside and inside the facility pertaining to COVID-19 precautions.

LPA met with the 1 resident at approximately 2:38 PM.

At approximately 2:44 PM, LPA conducted a physical plant tour. LPA observed all rooms, walls, and floors to be clean and in good condition. All furniture was in good repair. Outdoor and indoor pathways were free from obstruction. A back door provided access to a patio. The door was unlocked from the inside and locked on the outside.

LPA requested two additional contact numbers for the facility. Both were provided through email from the Administrator.

LPA conducted exit interview and issued report.

SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021
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 1