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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191224046
Report Date: 01/10/2022
Date Signed: 01/10/2022 04:04:24 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:VERDUGO HILLS FAMILY YMCAFACILITY NUMBER:
191224046
ADMINISTRATOR:SUZANNE MCMILLENFACILITY TYPE:
850
ADDRESS:6840 FOOTHILL BOULEVARDTELEPHONE:
(818) 352-3255
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:68CENSUS: 23DATE:
01/10/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:13 PM
MET WITH:Director, Chelsea Lawrence and Branch Manager, Annie Azizian TIME COMPLETED:
01:14 PM
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Licensing Program Analyst met with Director, Chelsea Lawrence and Branch Manager (BM), Annie Azizian today for the purpose o conducting a Plan of Correction inspection to clear citation issued on 12/20/2022. During this inspection, LPA was presented with 2 invoices dated 12/30/2021 and 1/7/2022. BM states they now have a monthly contract with La Canada Pest Control Company. Citation has been cleared.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022
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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