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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425801560
Report Date: 04/20/2021
Date Signed: 04/20/2021 04:22:27 PM

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
FACILITY NAME:EDELWEISS HOME FOR THE ELDERLYFACILITY NUMBER:
425801560
ADMINISTRATOR:MILDRED HUG-DEMONTEVERDEFACILITY TYPE:
740
ADDRESS:7067 ARMSTRONG ROADTELEPHONE:
(805) 679-5010
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:6CENSUS: 0DATE:
04/20/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Mildred Hug, AdministratorTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Kristin Kontilis conducted a case management visit with Administrator Mildred Hug. The visit was conducted virtually due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures.
On 2/3/2021, Administrator Mildred Hug notified CCL via telephone to state that the facility is going to be closed due to financial reasons. LPA Kontilis sent closure instructions per §1569.682 to Administrator via email.
On 3/8/2021, Administrator Mildred Hug notified CCL via telephone regarding facility closure and to further inquire about transferring residents from the facility to the Administrator’s sister facility.
On 4/19/2021, Administrator Mildred Hug provided facility closure documents including but not limited to residents’ transfer information. LPA Kontilis contacted Administrator to inquire about the residents’ transfer. Administrator stated there were three residents residing in the at the time of the closure and all three voluntarily transferred to the sister facility on 3/22/2021. Administrator provided documentation showing notices to transfer their residency along with signed documents from residents’ responsible parties.
During today’s visit, LPA toured the facility and observed that there were no residents in care residing at the facility. Licensee indicated that she will mail the facility license to Community Care Licensing Division’s Woodland Hills office.

No citations issued during today’s visit.

A telephonic exit interview was conducted with the administrator and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021
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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