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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610360
Report Date: 02/17/2023
Date Signed: 02/17/2023 01:31:51 PM

Document Has Been Signed on 02/17/2023 01:31 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:BUENAVISTA LIVING WELL CENTERFACILITY NUMBER:
197610360
ADMINISTRATOR:ENOLA, JAMELENE JOY S.FACILITY TYPE:
735
ADDRESS:1106 WEST AVENUE OTELEPHONE:
(253) 353-0587
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 6CENSUS: DATE:
02/17/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jamelene Joy S. EnolaTIME COMPLETED:
11:45 AM
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On 2/10/2023, Licensing Program Analyst (LPA) Melissa Spaeth conducted an announced Pre-Licensing visit to this facility and met with applicants Jamelena Joy S. Enola & Jean Sevilla. During the visit, LPA observed construction materials beside the detached staff living quarters. The applicants stated renovation projects were completed but applicants are waiting for a locked storage unit to be installed on the property.

LPA Spaeth and Applicant Enola toured the outside at 11:10 am and LPA observed the construction materials had been removed from the side of the detached staff living quarters. The locked storage unit was installed on the property. LPA did not observe any health or safety issues during the tour.

This report will be forwarded to the Centralized Application Bureau (CAB) for approval.

Exit interview was conducted and a copy of the signed report was given to the Applicant.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2023
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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