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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801598
Report Date: 11/02/2021
Date Signed: 11/02/2021 03:14:54 PM

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 IIIFACILITY NUMBER:
565801598
ADMINISTRATOR:JOANN TRUPIANOFACILITY TYPE:
740
ADDRESS:3216 YARDLEY PLACETELEPHONE:
(805) 581-9422
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:6CENSUS: 0DATE:
11/02/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Joann TrupianoTIME COMPLETED:
03:14 PM
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Licensing Program Analyst (LPA) Martha Guzman Chavez conducted an unannounced Case Management-Other visit to the above facility. LPA met with Administrator Joann Trupiano as the purpose of the visit was to conduct a final walk-through of the facility prior to closure. Entrance interview conducted.

On 09-30-2021, LPA Peraldi called Administrator Joann in regards to request received via fax to close facility Angels III. Administrator confirmed to LPA Peraldi that remaining two residents had been relocated to other licensed facilities, Angels II and Embracing Seniors. Administrator stated she wanted to surrender her license for this facility.

During today’s visit, LPA observed facility to be vacant and verified that no care and supervision was being provided. Administrator Joann Trupiano surrendered License to LPA Guzman Chavez. The facility will be closed effective November 02, 2021 in the Licensing Information System (LIS).

Exit interview conducted. A copy of report issued to Joann via email.

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

DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021
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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