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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850244
Report Date: 12/19/2024
Date Signed: 12/19/2024 03:05:09 PM

Document Has Been Signed on 12/19/2024 03:05 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:PALS SKILLS CENTERFACILITY NUMBER:
565850244
ADMINISTRATOR/
DIRECTOR:		POURAN MOUSAZADEHFACILITY TYPE:
775
ADDRESS:1310 E MAIN STREETTELEPHONE:
(562) 489-3859
CITY:SANTA PAULASTATE: CAZIP CODE:
93060
CAPACITY: 30CENSUS: 9DATE:
12/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:48 PM
MET WITH:Christina Buth-OkatchTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Kelly Dulek arrived at the Adult Day Program (ADP) unannounced to conduct a case management - other visit at 01:48PM. The LPA met with Licensee Christina Buth-Okatch. Entrance interview conducted.

LPA Dulek visited and toured the day program today to determine if it is feasible to convert the day program into an emergency shelter when a natural disaster happens in the area. Further discussion will occur between the Regional Centers and the Department of Developmental Services. Licensee will be notified once a decision is made.

No citations issued. Exit interview conducted. A copy of today's report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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