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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609315
Report Date: 05/23/2023
Date Signed: 05/23/2023 04:26:23 PM


Document Has Been Signed on 05/23/2023 04:26 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, 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: 0DATE:
05/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:13 PM
MET WITH:Arabella CarriedoTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) LaQueena Lacy arrived to the facility on 05/23/2023 at 3:13pm and met with Arabella Carriedo and explained the purpose of the visit. LPA was informed by telephone by the administrator on 05/19/2023 at 9:44am that the facility is closed an has been closed as of November 2022. At the time of the closure one (01) resident resided at the facility, and had moved home with family back in November of 2022.
LPA conducted a physical plant tour at 3:25pm the following was observed, The facility has six (06) bedrooms and two (02) bathrooms. Per Arabella they currently are renting bedrooms to independent occupants and they do not require any care or supervision. During the inspection LPA observed (6) bedrooms to have personal items, clothing, televisions, bed etc. LPA spoke with (2) occupants whom confirm they are independent, renting a room and pay rent monthly and do not require any care and supervision. One (01) out of (02) occupants confirm they take medication and they administer, and store their own medication. The home has an attached garage that is storing a car, personal items, luggage and cleaning supplies.

The facility license was surrendered by Arabella Carriedo during the visit.

No Health and safety issued noted or concerned at the time of the visit.

Exit interview conducted and copy of report issued.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena LacyTELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023
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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