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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197690036
Report Date: 07/13/2023
Date Signed: 07/13/2023 03:21:20 PM

Document Has Been Signed on 07/13/2023 03:21 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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ELEVATIONSFACILITY NUMBER:
197690036
ADMINISTRATOR:JORDAN ARONOFFFACILITY TYPE:
772
ADDRESS:3836 KANAN ROADTELEPHONE:
(858) 695-4069
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY: 6CENSUS: 4DATE:
07/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:
Nesha Tandon		TIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced Case Management - Other visit pertaining to a Summary Report conducted on May 31st, by the Department of Health Care Services (DHCS). Upon arrival LPA met with Nesha Tandon and explained the reason for the visit.

On 07/06/2023, the Department received the summary report from DHCS, which indicated a Plan of Action was issued to Elevations to make corrections on several deficiencies.

Today LPA conducted physical plant, interviewed staff as well as reviewed and obtained copies of pertinent documentation relevant to the Summary report.

No immediate health and safety concerns were observed during today's inspection. The LPA has determined further investigation is needed. 

Exit interview conducted and copy of report issued to Tandon.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
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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