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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247208804
Report Date: 06/18/2021
Date Signed: 07/07/2021 12:50:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:WESTSIDE ELDERLY CARE IIFACILITY NUMBER:
247208804
ADMINISTRATOR:TOSTADO, MARIA HFACILITY TYPE:
740
ADDRESS:656 SANTA BARBARATELEPHONE:
(209) 826-7120
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:6CENSUS: 0DATE:
06/18/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria Tostado-LicenseeTIME COMPLETED:
10:00 AM
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On this date, Licensing Program Analyst (LPA) D. Ayers arrived at the facility to conduct an announced Case Management inspection. LPA met with Licensee Maria Tostado.

The purpose of this inspection was to confirm that the facility was uninhabited. LPA toured the facility. LPA and licensee completed closure survey. Facility will be closed effective 6/18/2021, pending Licensing Program Manager approval. Exit interview conducted. A copy of the report was provided via email.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David AyersTELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
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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