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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603564
Report Date: 02/15/2023
Date Signed: 02/15/2023 11:55:21 AM


Document Has Been Signed on 02/15/2023 11:55 AM - 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:
02/15/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Judy Agabin - Person in Charge TIME COMPLETED:
12:10 PM
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Licensing Program Analyst(s) (LPA) Mary Flores and Jose Villalobos 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 the visit:
LPAs interviewed 16 individuals that reside at the location and 3 care persons.


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: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
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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