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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802420
Report Date: 06/06/2023
Date Signed: 06/06/2023 12:05:01 PM


Document Has Been Signed on 06/06/2023 12:05 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:PARK VISTA SENIOR LIVING 1-3FACILITY NUMBER:
565802420
ADMINISTRATOR:CHRISTOPHER ROMOFACILITY TYPE:
740
ADDRESS:370 ARCTURUS STREETTELEPHONE:
(805) 241-8000
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:6CENSUS: 0DATE:
06/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Sherry NazariTIME COMPLETED:
10:35 AM
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Licensing Program Analyst (LPA) Elsie Campos conducted a Case Management visit today at 10:20 a.m. with Administrator Sherry Nazari. The purpose of this visit is to document the closure of this facility and ensure all clients have been relocated.

The licensee notified Community Care Licensing Division (CCLD) on April 4th, 2023 that the facility was going to close. A copy of the 60-Day notices issued to the residents had been approved and received by the Department.

The LPA conducted a physical plant tour of the property at 10:25 a.m. and observed no residents at this location. It was confirmed that the six 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 issued. The LPA obtained the license during today’s visit.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023
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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