<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197610258
Report Date:
03/18/2024
Date Signed:
03/18/2024 11:26:08 AM
Document Has Been Signed on
03/18/2024 11:26 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
HOME FOR THE ELDERLY
FACILITY NUMBER:
197610258
ADMINISTRATOR:
FRANCISCO FABREGAS
FACILITY TYPE:
740
ADDRESS:
19825 LEADWELL ST.
TELEPHONE:
(818) 718-2750
CITY:
CANOGA PARK
STATE:
CA
ZIP CODE:
91306
CAPACITY:
6
CENSUS:
5
DATE:
03/18/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
FRANCISCO FABREGAS- Administrator
TIME COMPLETED:
11:35 AM
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
Licensing Program Analyst (LPA) Mariana Agban conducted a case management visit to follow up on the facility closure. LPA conducted physical plant to ensure the health and safety of the residents. LPA met with Administrator Francisco Fabergas and explained the reason for the visit. Facility's current census is 5. Administrator is still working with placement agencies to relocate residents. LPA reminded Administrator that the 60-day notice was due on 03/15/24. Administrator will be emailing LPA the current update on each resident's relocation. Exit Interview conducted a copy of this report delivered.
SUPERVISOR'S NAME:
Eva Miller
TELEPHONE:
(818) 596-4373
LICENSING EVALUATOR NAME:
Mariana Agban
TELEPHONE:
818-738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
03/18/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/18/2024
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