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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197610102
Report Date:
12/01/2020
Date Signed:
12/01/2020 02:34:40 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:
ALLEVIATE CARE
FACILITY NUMBER:
197610102
ADMINISTRATOR:
ESTRADA, LOURDES M.
FACILITY TYPE:
740
ADDRESS:
20930 GAULT STREET
TELEPHONE:
(818) 378-2772
CITY:
CANOGA PARK
STATE:
CA
ZIP CODE:
91303
CAPACITY:
6
CENSUS:
DATE:
12/01/2020
TYPE OF VISIT:
Office
UNANNOUNCED
TIME BEGAN:
01:00 PM
MET WITH:
Lourdes Estrada
TIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) conducted a component III virtually through face-time with facility representative Lourdes Estrada. LPA completed the pre-licensing visit on 11/20/2020. LPA will let Central Application Unit know that pre-licensing and component III has been completed.
Exit Interview conducted.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
12/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/01/2020
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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