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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610049
Report Date: 06/29/2020
Date Signed: 06/29/2020 03:31:04 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:CASTLEMERE SENIOR HOMEFACILITY NUMBER:
197610049
ADMINISTRATOR:JOSEPH-NURSE, VERONICAFACILITY TYPE:
740
ADDRESS:23216 VIA CALISEROTELEPHONE:
(661) 200-3213
CITY:VALENCIASTATE: CAZIP CODE:
91355
CAPACITY:6CENSUS: 2DATE:
06/29/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Veronica Joseph-Nurse/ AdministratorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Patrick Shanahan conducted a Pre licensing visit at 1 pm and met with the Administrator Veronica Joseph-Nurse. Due to the situation surrounding the Covid-19, and to implement mitigation measures, today’s visit was conducted telephonically. This is change of ownership application. A dementia plan of operation was submitted.
LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. First-aid kit is complete; facility has adequate linen, perishable and nonperishable food supplies. Hot water measured at 106.4 degrees Fahrenheit. There is no swimming pool or other body of water. Facility has working alarms on all exits. The backyard is completely fenced and gated with self-latching mechanisms. There is patio area backyard with table and chairs for resident use. All chemicals and sharps are in locked cabinets and drawers. Facility has 2 bathrooms; resident bathrooms have required grab bars installed. Fire Clearance is approved for 1 bedridden and 5 non-ambulatory. There is 4 single occupancy and 1 shared. The washer and dryer are located in the garage.
Facility is in compliance with Title 22 Regulations at this time. This report will be sent to the Centralized Application Unit (CAU). You will be notified by the CAU Analyst when your license has been approved.

You are not allowed to begin operating until you have been notified that your license has been approved by the CAU Analyst. Failure to comply could affect approval of your license.
Exit interview held and report issued. Due to the Covid 19 pandemic, a signature was not gained on this report. A copy of the report was emailed and a "wet" signature was gained and will be available in the facility hard file.
SUPERVISOR'S NAME: Maryjo SchnitzerTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2020
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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