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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610258
Report Date: 03/26/2024
Date Signed: 03/26/2024 03:00:46 PM


Document Has Been Signed on 03/26/2024 03:00 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:HOME FOR THE ELDERLYFACILITY NUMBER:
197610258
ADMINISTRATOR:FRANCISCO FABREGASFACILITY TYPE:
740
ADDRESS:19825 LEADWELL ST.TELEPHONE:
(818) 718-2750
CITY:CANOGA PARKSTATE: CAZIP CODE:
91306
CAPACITY:6CENSUS: 2DATE:
03/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:FRANCISCO FABREGAS- AdministratorTIME COMPLETED:
03:15 PM
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Licensing Program Analysts (LPAs) Leizl De La Cerra, Gary Tan, and Raymond Comer conducted a case management visit to follow up on the facility closure. LPAs conducted physical plant to ensure the health and safety of the residents. LPAs met with Administrator Francisco Fabergas and explained the reason for the visit. Facility's current census is 2. Administrator continues to work with placement agencies and families of the residents for their relocation. LPAs reminded Administrator that the 60-day notice was due on 03/15/24. LPAs' interview with the administrator stated that his parents bought the house and now under escrow. A follow up update regarding the new development will be emailed to LPM Eva Miller.

LPAs conducted interview with current residents and stated that they are doing well and there was no concern at this time.

There is no health and safety issue during this visit.

Exit Interview conducted a copy of this report delivered.

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond ComerTELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:
DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2024
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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