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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609325
Report Date: 03/12/2025
Date Signed: 03/12/2025 12:14:43 PM

Document Has Been Signed on 03/12/2025 12:14 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:INDEPENDENT ENTERPRISE HEALTH CARE INCFACILITY NUMBER:
197609325
ADMINISTRATOR/
DIRECTOR:		JIM DURANDOFACILITY TYPE:
740
ADDRESS:36722 ROSE STTELEPHONE:
(661) 917-4380
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY: 4CENSUS: 3DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:James Durando- AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 3/12/2025 at approximately 09:40 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the caregiver and LPA stated the reason for their visit. Administrator James Durando arrived shortly after to assist with today’s visit.

LPA asked for the census and Staff/Resident Roster. LPA conducted a physical plant tour at approximately 11:00 AM and the following was noted:

The facility is a single unit building with five (5) bedrooms and two (2) bathrooms currently occupying three (3) residents. The facility has an approved fire clearance for two (2) ambulatory residents and two (2) non-ambulatory residents. The facility is vendor through North Los Angeles Regional Center (NLARC) and is being operated at a Level III Residential Facility for the Elderly. Sign in sheet, hand sanitizer, gloves and masks are available.

Common areas: The living room and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 73°F. LPA observed a fire extinguisher to be located near the kitchen and dated 05/30/24. LPA observed required postings such as See/Say Something, Facility License, and Personal Rights alongside the dinning area. A fireplace was observed to be covered and inaccessible to residents. A working telephone was observed.

Due to time constraints this required annual will be completed at a later time.

Exit interview conducted/Copy of report given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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