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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610114
Report Date: 02/26/2021
Date Signed: 02/26/2021 10:44:24 AM

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:ANGELA'S CARE VILLAFACILITY NUMBER:
197610114
ADMINISTRATOR:GUNATILAKE, SHENELLE JFACILITY TYPE:
740
ADDRESS:18908 STRATHERN STREETTELEPHONE:
(818) 414-1175
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 0DATE:
02/26/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Shenelle Gunatlake / AdministratorTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Patrick Shanahan conducted a Pre-Licensing Visit & Inspection. Applicant Representative Shenelle Gunatlake met with the LPA. An Application to operate a Residential Care Facility for the Elderly was received by Community Care Licensing. A Fire Safety Inspection Request was completed and approved for a maximum capacity of six (6), 1 Bedridden and 5 non-ambulatory. Due to the Covid -19 pandemic, this pre-licensing was conducted via video phone. No digital signature was attained and a copy of the report was emailed to the administrator. A "wet" signature is on file in the main facility folder. Comp III was also conducted.

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 110 degrees Fahrenheit. There is swimming pool. The backyard is fenced and gated with self-latching mechanisms. There is patio area in the backyard with table and chairs for resident use. All chemicals and sharps are stored in a locked cabinet. Medications are stored in a locked med-room inside the office. Facility has 2 bathrooms and 3 bedrooms. Fire Clearance is approved for 1 bedridden and 5 non-ambulatory residents.The washer and dryer are located in a locked room next to the kitchen.

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.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021
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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