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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800983
Report Date: 08/11/2023
Date Signed: 08/11/2023 03:42:50 PM


Document Has Been Signed on 08/11/2023 03:42 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:LINA'S GUEST HOMEFACILITY NUMBER:
565800983
ADMINISTRATOR:CELINA B. ALBUNAFACILITY TYPE:
740
ADDRESS:2221 KEPLER DRIVETELEPHONE:
(805) 487-3816
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:6CENSUS: 4DATE:
08/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:02 PM
MET WITH:Elizabeth Galang ManguneTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Case Management - Other inspection at the facility today. When the LPA arrived they met with Caregiver Elizabeth Galang Mangune. The LPA contacted Licensee/Administrator Lina Albuna at 3:08 PM and informed her of the inspection. The Administrator stated they were back from vacation but they were unable to come to the facility at this time.

During today's visit, the LPA conducted a physical plant tour. There are currently four residents and two staff present. The LPA observed two residents sitting in the living room and two residents in their bedrooms. The LPA did not observe any immediate health or safety concerns during the inspection. The facility had a sufficient supply of perishable and non-perishable food and items that could pose a danger were secured.

No deficiencies were cited during today's inspection. Exit interview conducted. A copy of the report was provided.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2023
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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