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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197610360
Report Date:
03/15/2024
Date Signed:
03/15/2024 03:16:01 PM
Document Has Been Signed on
03/15/2024 03:16 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
WOODLAND HILLS S.ASC
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BUENAVISTA LIVING WELL CENTER
FACILITY NUMBER:
197610360
ADMINISTRATOR:
ENOLA, JAMELENE JOY S.
FACILITY TYPE:
735
ADDRESS:
1106 WEST AVENUE O
TELEPHONE:
(253) 353-0587
CITY:
PALMDALE
STATE:
CA
ZIP CODE:
93551
CAPACITY:
6
CENSUS:
0
DATE:
03/15/2024
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
11:28 AM
MET WITH:
Jamelene Enola
TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit and was greeted by the Administrator. LPA stated the purpose of the visit was to conduct an annual inspection. The Administrator confirmed there no clients living in the facility. The Administrator is waiting for the Regional Center to vendor the facility.
The facility is licensed for two (2) ambulatory and four (4) non-ambulatory clients.
LPA Spaeth and the administrator toured the facility at 11:35 am until 11:45 am. LPA observed there are no clients living in the facility.
There are no deficiencies to report at this time. Exit interview and a copy of the report was given.
SUPERVISORS NAME
:
Troy Agard
LICENSING EVALUATOR NAME
:
Melissa Spaeth
LICENSING EVALUATOR SIGNATURE
:
DATE:
03/15/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/15/2024
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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