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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
198602362
Report Date:
12/11/2023
Date Signed:
12/26/2023 08:15:38 PM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
12/26/2023 08:15 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
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
HARRIET HOUSE
FACILITY NUMBER:
198602362
ADMINISTRATOR:
EASTON, ALYCE
FACILITY TYPE:
735
ADDRESS:
24 W HARRIET
TELEPHONE:
(626) 794-4103
CITY:
ALTADENA
STATE:
CA
ZIP CODE:
91001
CAPACITY:
12
CENSUS:
0
DATE:
12/11/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Estrella- Administrator
TIME COMPLETED:
10:15 AM
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On 12.11.2023 an attempted visit was made for an unannounced visit to the facility for their annual inspection. License Program Analysts (LPA) Leslie Ngo-Castaneda was greeted by staff Maryann and advised for the purpose of the visit. Staff contacted administrator immediately and was told that residents unfortunately residents are covid positive and needed to be re-scheduled. thank you
SUPERVISORS NAME
:
Nichelle Gillyard
LICENSING EVALUATOR NAME
:
Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/11/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/11/2023
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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