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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600256
Report Date: 02/02/2022
Date Signed: 02/02/2022 01:13:15 PM

Document Has Been Signed on 02/02/2022 01:13 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:EUNICE HOMEFACILITY NUMBER:
197600256
ADMINISTRATOR:AGBEDE, SONNYFACILITY TYPE:
735
ADDRESS:11611 BALBOA BLVD.TELEPHONE:
(818) 368-9242
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 6DATE:
02/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Lina Biluan-House ManagerTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility and was greeted by facility staff. The LPA's temperature was taken and documented by staff before being allowed entry. The house manager was called and came to the facility shortly after the call.

The infection control portion of the Required Annual was conducted and the facility is following their mitigation plan.

The LPA was able to briefly tour the for healthy and safety concerns and none were observed. The smoke and carbon monoxide detectors were tested and function properly.

No deficiencies were observed during todays visit.

Exit interview conducted and report issued.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2022
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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