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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800476
Report Date: 08/06/2024
Date Signed: 08/06/2024 04:01:25 PM


Document Has Been Signed on 08/06/2024 04:01 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:ATRIA LAS POSASFACILITY NUMBER:
565800476
ADMINISTRATOR:ROMAN SIERRA TOVARFACILITY TYPE:
740
ADDRESS:24 LAS POSAS RDTELEPHONE:
(805) 987-9872
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:140CENSUS: 111DATE:
08/06/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Kawana AnthonyTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Teresa Camara conducted a collateral visit regarding a complaint for another facility (complaint control number 29-AS-20240612094331). LPA met with interim executive director Kawana Anthony, Operations Specialist and explained the reason for the visit.

LPA met with Resident 1 (R1) at 3:45 p.m.

No deficiencies observed. Exit interview conducted and report issued.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:
DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2024
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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