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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801456
Report Date: 05/23/2024
Date Signed: 05/23/2024 11:28:31 AM

Document Has Been Signed on 05/23/2024 11:28 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:CEDAR HOUSEFACILITY NUMBER:
565801456
ADMINISTRATOR/
DIRECTOR:		LOUISA MAE ESPENAFACILITY TYPE:
735
ADDRESS:161 MARKER AVENUETELEPHONE:
(805) 484-0271
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 6CENSUS: 6DATE:
05/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:52 AM
MET WITH:Louisa Mae EspenaTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Teresa Camara conducted a case management - incident visit regarding a self-reported incident which took place on 5/5/2024. LPA was joined by Tri-Counties Regional Center (TCRC) Quality Assurance Specialist (QAS) Liz Aced-Arnett. LPA and QAS met with the administrator Louisa Mae Espena and explained the reason for the visit.

At 8:52 a.m. LPA and QAS were greeted by the administrator. At 9:10 a.m. LPA and QAS interviewed the administrator. All clients were at their day programs during the visit. At 10:00 a.m. LPA reviewed and obtained pertinent documents. LPA and QAS discussed client 1 (C1) and client 2 (C2) requiring exception requests due to their age. The administrator will submit those requests by 5/28/2024. Further investigation is necessary.

No deficiencies cited. Exit interview conducted and report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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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