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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850221
Report Date: 10/15/2024
Date Signed: 11/01/2024 04:35:59 PM

Document Has Been Signed on 11/01/2024 04:35 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:GLEN PARK AT OJAIFACILITY NUMBER:
565850221
ADMINISTRATOR/
DIRECTOR:
GARY Y LEEFACILITY TYPE:
740
ADDRESS:225 N LOMITA AVETELEPHONE:
(805) 646-2402
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY: 48CENSUS: 16DATE:
10/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Roman TovarTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Teresa Camara conducted a required annual visit. LPA met with administrator Roman Tovar and assistant administrator Leticia Hernandez and explained the reason for the visit.

At 3:00 p.m. LPA conducted a physical plan tour accompanied by the assistant administrator. LPA toured resident rooms, bathrooms, outdoor areas, and the kitchen.

KITCHEN: The kitchen is left locked so residents cannot enter. The kitchen was clean and the appliances appeared to be functional The facility's main pantry is air conditioned and located outside. The pantry had non-perishable foods, perishable foods, and three large freezers with perishable foods. Food was also stored in the kitchen and another pantry inside the facility which had more non-perishable food and water. There was a sufficient supply of perishable, non-perishable foods and water.
RESIDENT ROOMS: There are currently thirteen rooms for residents. These rooms can be shared or can be single rooms. There are three rooms used as model rooms. There are six rooms upstairs which are used as office space and storage. The upstairs rooms can only be accessed by stairs so they are not in use for residents at this time. Rooms housing residents appeared to be clean with appropriate furnishings, bedding and sufficient lighting.
BATHROOMS: The facility has two shower rooms. Two of the resident rooms have full bathrooms; one is a model room and the other has a resident. The facility has eleven half bathrooms; some are private and others are "jack and jill" bathrooms between two rooms. Bathrooms appeared to be clean and had grab bars. The shower rooms had non-skid mats.
OUTDOOR: The facility has three patio areas equipped with seating and shade for residents.

This annual will continue at a later date. Exit interview conducted and report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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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