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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800845
Report Date: 08/26/2021
Date Signed: 08/26/2021 10:11:18 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
FACILITY NAME:ANGELS ON TRACYFACILITY NUMBER:
565800845
ADMINISTRATOR:JO ANN TRUPIANOFACILITY TYPE:
740
ADDRESS:2409 TRACY AVE.TELEPHONE:
(805) 583-3293
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:6CENSUS: 0DATE:
08/26/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jo An TrupianoTIME COMPLETED:
10:10 AM
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On 8-26-2021, Licensing Program Analyst (LPA) Martha Guzman Chavez conducted an announced Case Management-Other visit to the above facility. LPA met with Administrator Jo Ann Trupiano as the purpose of the visit was to conduct a final walk-through of the facility prior to closure. Entrance interview conducted.

During today’s visit, LPA observed facility to be vacant and verified that no care and supervision was being provided. LPA inspected all client rooms and observed them to be uninhabited and empty of personal effects and furniture. The house is currently empty and listed for sale. During today's visit, Administrator surrendered license to LPA. The facility will be closed effective August 26, 2021 in the Licensing Information System (LIS).

Exit interview conducted. A copy of report issued to Jo Ann Trupiano via email.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Guzman-ChavezTELEPHONE: (818) 596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
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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