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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191222267
Report Date: 03/08/2022
Date Signed: 03/08/2022 10:39:18 AM


Document Has Been Signed on 03/08/2022 10:39 AM - 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., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:GOLDEN YEARSFACILITY NUMBER:
191222267
ADMINISTRATOR:MUDER, EVANGELIAFACILITY TYPE:
740
ADDRESS:15822 MAYALL ST.TELEPHONE:
(818) 892-4467
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 0DATE:
03/08/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Evangelia MuderTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Pitz conducted an unannounced visit on this day in order to confirm the facility's status. LPA was greeted by the licensee and told the same information LPAs were given on 8/5/21- that the facility is temporarily not in operation due to licensee health concerns. LPA toured the facility and confirmed that there are no residents in care. Licensee was advised that annual fees must still be paid if they wish to maintain a license. Licensee stated that they would make a final determination about whether to close the facility and surrender their license within the next week and notify LPA.


Report reviewed, signed and delivered. Exit interview conducted, no deficiencies cited.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Alexander PitzTELEPHONE: (805) 450-1627
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022
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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