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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801615
Report Date: 03/10/2021
Date Signed: 03/10/2021 02:31:42 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:BERKSHIRE ELDER CAREFACILITY NUMBER:
565801615
ADMINISTRATOR:AILEEN VALENTINOFACILITY TYPE:
740
ADDRESS:1844 BERKSHIRE DRIVETELEPHONE:
(805) 732-3810
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY:6CENSUS: 0DATE:
03/10/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Aileen ValentinoTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Ashley Smith conducted a Case Management visit today at 2pm. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s visit was conducted virtually via FaceTime with Administrator Aileen Valentino.

The purpose of this inspection is to document the closure of this facility and ensure all residents have been relocated. The licensee notified Community Care Licensing Division (CCLD) in February of 2021 that the licensee intended to close the facility for personal reasons. A copy of the 60-Day notices issued to the residents had been approved and received by the Department.

The LPA conducted a virtual physical plant tour and observed no residents at this location. It was confirmed that the five residents were relocated to licensed facilities. Based on observation and interview, the facility is no longer operating as a licensed facility.

Closure of this facility has been confirmed. Exit interview conducted and a copy of the report was emailed to Administrator Aileen Valentino for signature. The LPA provided the Administrator with the Regional Office address and asked them to mail in the license as soon as possible.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2021
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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