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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603564
Report Date: 02/08/2023
Date Signed: 02/08/2023 12:19:37 PM


Document Has Been Signed on 02/08/2023 12:19 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:
02/08/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Judy Agabin - Person in chargeTIME COMPLETED:
12:30 PM
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Licensing Program Analyst(s)(LPA) Mary Flores, Jose Villalobos, and Erik Zaragoza conducted an unannounced case management visit at the location. LPAs met with Judy Agabin Person in charge and explained the reason for the visit.

The following was conducted during this visit:
  • LPAs tour the facility and observed 14 individuals in care and 3 living in care persons.
  • LPAs conducted interviews with 15 individuals.
  • During the visit one (1) individual was send out to the hospital.

Exit interview was conducted with Judy Agabin person in charge and a copy of this report was provided.
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023
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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