<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801124
Report Date: 07/28/2023
Date Signed: 07/28/2023 10:40:03 AM

Document Has Been Signed on 07/28/2023 10:40 AM - 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 NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:PCS-CACHUMAFACILITY NUMBER:
565801124
ADMINISTRATOR:ANGELICA SERRANOFACILITY TYPE:
735
ADDRESS:1324 CACHUMA AVENUETELEPHONE:
(805) 659-2743
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY: 4CENSUS: 4DATE:
07/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Didi Daniels TIME COMPLETED:
08:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At 7:50 a.m., Licensing Program Analysts (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual. When arrived, the LPA found the facility under construction due to a recent water leak. The LPA toured the facility with the construction workers. There were no clients at the facility during the time of visit. The LPA spoke with Administrator Didi Daniels who provided relocation information for the clients. The LPA will continue the annual at a later date.

Exit interview conducted. Copy of this report provided to Administrator Didi Daniels.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1