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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802457
Report Date: 08/25/2023
Date Signed: 08/25/2023 09:00:29 AM

Document Has Been Signed on 08/25/2023 09:00 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:KESHER OLAMFACILITY NUMBER:
565802457
ADMINISTRATOR:HERSHKOVITZ, CAMIFACILITY TYPE:
735
ADDRESS:4234 HITCH BLVDTELEPHONE:
(805) 306-0606
CITY:MOORPARKSTATE: CAZIP CODE:
93021
CAPACITY: 8CENSUS: 4DATE:
08/25/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Cami HerskovitzTIME COMPLETED:
09:15 AM
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Licensing Program Analyst (LPA) Martha Arroyo conducted a case management – other to inspect the newly constructed Accessory Dwelling Unit (ADU) that has been added to the facility. Upon arrival, LPA met with Administrator, Cami Hershkovits and the reason for the visit was explained. Entrance interview conducted.

The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

LPA observed the ADU which has an additional client common area, four (4) bedrooms, two (2) bathrooms, and a kitchen. During the visit, Administrator stated three (3) bedrooms will be for clients and one (1) bedroom will be for a live in staff. Additionally, each building will have a live-in staff not including herself. Fire extinguisher is present in the ADU and is fully charged. Smoke alarms functioning and ADU has sprinklers. ADU has a washer and dryer for client use. All walkways were free from obstruction. The facility which includes two (2) properties has been updated to have a capacity of eight (8) clients.

Exit interview conducted. No citations issued at this time. A copy of the report was issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2023
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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