<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610258
Report Date: 04/18/2024
Date Signed: 04/18/2024 10:38:44 AM


Document Has Been Signed on 04/18/2024 10:38 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
CCLD Regional Office, 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: 0DATE:
04/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Erlinda Sajor TIME COMPLETED:
10:40 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
At 10:07am, Licensing Program Analyst (LPA) Tihesha Smith conducted a Case Management visit due to facility closure. Upon arrival, LPA Smith disclosed the reason for the visit. The staff confirmed that has not had any residents since April 15 2024. The staff surrendered original license to the LPA during the visit.

LPA conducted a physical plant tour and observed that the facility was vacant with no residents present.
Closure of this facility has been confirmed during today’s visit. Administrator was contacted and reminded not to admit/retain any residents at the home who require care and supervision.

Exit interview conducted/copy of report given.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha SmithTELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024
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