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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401700013
Report Date: 11/02/2022
Date Signed: 11/04/2022 10:30:59 AM


Document Has Been Signed on 11/04/2022 10:30 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 11/04/2022 10:25 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

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This is an amended report. Census is 0. On 11/02/22 at 10:50 am, Licensing Program Analyst (LPA) Darlene Chavez attempted to conduct a closure visit. LPA met with Chris Wohlwend, Administrator, and explained the reason for the visit.

The purpose of this inspection is to document the closure of the facility and ensure all residents have been relocated. The facility closure was initiated by the licensee. The licensee notified Community Care Licensing Division (CCLD) on March 18, 2022, that the licensee intended to close the facility due to lack of profitability. The licensee communicated with residents and families and confirmed that residents would be relocated to other assisted living facilities.

LPA conducted a physical plant tour at 10:55 am and observed two residents occupying the facility. The administrator states that these residents are under independent living agreements and no services are being provided to them. Administrator says the rooms they occupy have been transferred to independent rooms as part of the closure and no longer are assisted living. LPA has verified both residents understand the licensed facility is closing and no care or supervision services will be provided, and both residents have private rental agreements in place with the property owner. All other resident rooms and common areas are not in use, except for the laundry and housekeeping rooms which the administrator states are being used to support independent living tenants. The two-story building is under renovation to independent living units.

Exit interview conducted and the report emailed to the administrator.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022
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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