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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
565802463
Report Date:
04/11/2022
Date Signed:
04/22/2022 03:23:50 PM
Document Has Been Signed on
04/22/2022 03:23 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:
PEOPLE'S CARE HOWE
FACILITY NUMBER:
565802463
ADMINISTRATOR:
CARLOS MARCIA
FACILITY TYPE:
735
ADDRESS:
3851 HOWE RD
TELEPHONE:
(805) 398-5096
CITY:
FILLMORE
STATE:
CA
ZIP CODE:
93015
CAPACITY:
6
CENSUS:
5
DATE:
04/11/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:15 AM
MET WITH:
Carlos Marcia
TIME COMPLETED:
02:40 PM
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This report has been amended. Please see Case Management Report dated 04/22/2022.
SUPERVISORS NAME
:
Kristin Heffernan
LICENSING EVALUATOR NAME
:
Angel Ascencio
LICENSING EVALUATOR SIGNATURE
:
DATE:
04/22/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/22/2022
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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