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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610258
Report Date: 03/11/2024
Date Signed: 03/11/2024 03:15:43 PM


Document Has Been Signed on 03/11/2024 03:15 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
N LA & CEN COA AC/SC, 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: 5DATE:
03/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH: Francisco Fabergas- AdministratorTIME COMPLETED:
03:30 PM
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 Analysts (LPAs) Mariana Agban and Raymond Comer conducted a case management visit to follow up on the facility closure. LPAs conducted the physical plant to ensure the health and safety of the residents. LPAs met with Administrator Franscisco Fabergas and explained the reason for the visit. LPAs were informed that one resident had already moved out 3 weeks ago and the current census are 5. Administrator stated he has been working with the resident's families and responsible persons for placement. Interviews with residents revealed that only a few are aware of the current loss of the property. LPAs obtained copies of LIC 500, residents roster, and contact information of responsible persons. Administrator stated that there are no hospice residents in the facility. Administrator emailed LPA Agban the status of 5 out 5 residents. Administrator was reminded to email LPA Agban immediately once a residents has been placed.
Exit Interview conducted and copy of this report delivered

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana AgbanTELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2024
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