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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602362
Report Date: 01/11/2024
Date Signed: 01/11/2024 12:37:42 PM

Document Has Been Signed on 01/11/2024 12:37 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 HOUSEFACILITY NUMBER:
198602362
ADMINISTRATOR:EASTON, ALYCEFACILITY TYPE:
735
ADDRESS:24 W HARRIETTELEPHONE:
(626) 794-4103
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 12CENSUS: 8DATE:
01/11/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Magdalena Estrada- AdministratorTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced inspection that was initiated on 12/28/2023. LPA met with Magdalena Estrada, administrator, and was advice for the reason of the visit.

With the assistance of the administrator LPA tour the facility at 12:21pm.

Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Records were checked for expired or missing certificates and clearances: LPA conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training.

Residents File: P&I balance

There will be no deficiencies issued during todays visit.

Exit Interview Conducted. Report Issued.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2024
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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