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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197604691
Report Date: 09/06/2022
Date Signed: 09/14/2022 06:58:54 AM


Document Has Been Signed on 09/14/2022 06:58 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:ANGIE'S HOME CARE, INC.FACILITY NUMBER:
197604691
ADMINISTRATOR:HEATH, ANGELAFACILITY TYPE:
740
ADDRESS:16456 LOS ALIMOS STTELEPHONE:
(818) 366-7906
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:4CENSUS: 4DATE:
09/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Angela HeathTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in order to conduct an infection control annual. LPA was greeted by the facility administrator and all covid 19 protocols were followed before being allowed entry into the facility.

The LPA used the infection control tool to complete the annual. The LPA was also able to briefly tour the home. LPA tested the smoke alarms and carbon monoxide detectors and they functioned properly. The fire extinguisher was observed in the kitchen to be functional.

The facility is currently following their infection control policy and no deficiencies were observed during today's visit. Exit interview conducted and report issued.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2022
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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