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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561702356
Report Date: 01/10/2025
Date Signed: 01/10/2025 12:26:04 PM

Document Has Been Signed on 01/10/2025 12:26 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:COTTONWOOD, THEFACILITY NUMBER:
561702356
ADMINISTRATOR/
DIRECTOR:
FLORO P CORTES JRFACILITY TYPE:
735
ADDRESS:1417 LIRIO AVENUETELEPHONE:
(805) 647-6046
CITY:SATICOYSTATE: CAZIP CODE:
93004
CAPACITY: 24CENSUS: 21DATE:
01/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:22 AM
MET WITH:Marcial San JuanTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Teresa Camara conducted a required annual inspection. LPA met with facility staff Marcial San Juan and explained the reason for today’s visit. Licensee/Administrator Floro Cortes was contacted via telephone but was unavailable to attend the visit with LPA.

Beginning at 11:35 a.m. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The following was observed:

Fire extinguishers were observed throughout the facility to be fully charged and last serviced 10/9/2024. Combination smoke detectors/carbon monoxide detectors throughout the facility were tested and were operational at the time of the visit.

BEDROOMS: There are 12 (twelve) total bedrooms, all of which are shared rooms and all were observed during the facility tour. Client bedrooms appeared to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Renovations have started in building three (3); clients are still able to stay in their room at this time.

RESTROOMS: Client restrooms were observed to contain sufficient amounts of soap and paper products in each restroom. One restroom in building four (4) is not available for use as renovations are being done.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, dining room furniture was observed to be in adequate condition. The temperature was maintained at a comfortable level throughout today's visit.

Exit interview conducted. No deficiencies cited at this time. LPA will return at a later date to continue this annual inspection. A copy of the report was provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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