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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850520
Report Date: 01/09/2025
Date Signed: 01/09/2025 10:33:32 AM

Document Has Been Signed on 01/09/2025 10:33 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:FINE GOLD MANORFACILITY NUMBER:
195850520
ADMINISTRATOR/
DIRECTOR:		CRISTINA GOMEZFACILITY TYPE:
740
ADDRESS:10537 MAGNOLIA BLVD.TELEPHONE:
(818) 761-5777
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91601
CAPACITY: 100CENSUS: 60DATE:
01/09/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:11 AM
MET WITH:Christina GomezTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Trevor Byrne conducted a follow-up pre-licensing visit to the above noted facility at 09:11 AM. The LPA met with Administrator, Christina Gomez entrance interview conducted and the reason for the visit was explained. This is a change of ownership application.

During the initial pre-licensing inspection conducted on 12/06/2024 LPA Byrne conducted a full physical plant tour, measured the water temperature in twenty-one (21) resident bathrooms, and observed the facility’s food supplies. During today’s visit LPA Byrne conducted a physical plant tour, measured the hot water temperature in ten (10) Resident bathrooms and one (1) common bathroom, observed window screens in ten (10) resident bedrooms and common areas, and observed the facility’s food and water supplies.

All bathrooms observed had their hot water temperature measured between 108.7 - 120 degrees Fahrenheit which is in compliance with regulation. All window screens observed were in good repair and were free of rips and tears. LPA observed the facility to have adequate emergency food and water supplies. Additionally, LPA observed a sufficient supply of perishable and non-perishable foods. All foods observed were within their expiration dates.

The Component Three (COMP III) orientation was completed with the facility Administrator Christina Gomez during the initial 12/06/2024 pre-licensing inspection.

This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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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