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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603564
Report Date: 02/01/2023
Date Signed: 02/01/2023 03:02:49 PM


Document Has Been Signed on 02/01/2023 03:02 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:MANSION AT WESTLAKEFACILITY NUMBER:
198603564
ADMINISTRATOR:PUNO-RIVERA, CARMANCITAFACILITY TYPE:
740
ADDRESS:1223 SOUTH ALVARADO STREETTELEPHONE:
(818) 804-0822
CITY:LOS ANGELESSTATE: CAZIP CODE:
90006
CAPACITY:24CENSUS: 0DATE:
02/01/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Judy Agabin - Person in Charge TIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst(s)(LPA) Mary Flores, Jose Villalobos, and Erik Zaragoza, Los Angeles Fire Department Fire Inspector Herbert Reddick, Department of Labor Wage and Hour Investigator Evelyn Rivera and Assistant District Director Susan Bacon, Adult Protective Services Social Worker Joycelyn Mantuano, and Long-Term Ombudsman Services Regional Manager Allison Virtue conducted an unannounced case management visit to conduct a health and safety check at the location. LPAs and agencies representatives met with Judy Agabin - Person in Charge and explained the reason for the visit. LPA Flores attempted to contact Carmancita Puno - Rivera over the phone.

During this visit a tour of the home was conducted with Judy Agabin - Person in Charge, LPAs, and fire inspector observed the following:
The following items were observed in need of repair and/or are a concern:
  • Smoke/carbon monoxide detectors in hallways and bedroom #10,11,and 12 were missing.
  • No furniture in bedroom #11 were observed.
  • Cleaning supplies, knives, and sharps were unlocked during the visit.
  • Holes in the wall in bedroom #2 and #3 were observed.
  • Home must follow fire department recommendations for safety provided during this visit.
  • Construction materials and paint cans were observed in the backyard.
  • construction/update in the attic was observed no city permits were available for review.
  • Broken windows were observed in bedroom #8 and living room.
  • A total of 25 people in care were observed.
  • Location was instructed to not accept new individuals during application process.

Exit interview was conducted with Judy Agabin Person in Charge and a copy of this report was provided.
(CONTINUED ON LIC 809C)
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023
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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