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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610312
Report Date: 07/01/2022
Date Signed: 07/01/2022 02:16:40 PM


Document Has Been Signed on 07/01/2022 02:16 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:JW CARE HOME, LLCFACILITY NUMBER:
197610312
ADMINISTRATOR:SALAMERO, JOJOMAURELI B.FACILITY TYPE:
740
ADDRESS:37944 MOONDANCE DRIVETELEPHONE:
(661) 285-3255
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:5CENSUS: 3DATE:
07/01/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:JOJOMAURELI B. SALAMERO, ADMINISTRATORTIME COMPLETED:
02:30 PM
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Regional Office scheduled a meeting to discuss the transition period of a new license. The Administrator met with Angela Kendrick(Regional Manager), Nichelle Gillyard(Licensing Program Manager) and Angela Panushkina(Licensing Program Analyst).
On 06/24/22 the Department received a notification that the Licensee, Josephine Wassel, passed away on 06/22/22.
The Centralized Application Bureau received a new application along with the fee on 06/27/22 and is in a pending process until further notification.

During todays meeting the following was discussed:
  • Health and Safety Code
  • Regulations
  • Copy of the Regulation and Health and Safety Code were issued to the Administrator
  • Copy of application status was issued on today's date
  • Department issued Emergency Approval To Operate for up to 60 days pending issuance or denial of a license.


Exit interview conducted and copy of this report issued to the Administrator.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2022
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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