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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606107
Report Date: 04/27/2022
Date Signed: 04/27/2022 12:08:14 PM

Document Has Been Signed on 04/27/2022 12:08 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:RICH-WAL CENTER #3, THEFACILITY NUMBER:
197606107
ADMINISTRATOR:SHIRLEY A. WALKERFACILITY TYPE:
735
ADDRESS:15832 BAHAMA STREETTELEPHONE:
(747) 529-6498
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 6CENSUS: 5DATE:
04/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:58 AM
MET WITH:Shirley Walker TIME COMPLETED:
12:15 PM
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On 04/27/22 at 11:50 a.m. Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conduct a Case Management visit. Facility met with Administrator Shirley Walker and the purpose of the visit was explained.

On 04/26/22 LPA Martinez conducted an announced Annual visit. In this visit LPA observed the fire extinguisher to be last serviced on 08/06/2020. LPA issued a violation and an immediate $500 civil penalty. LPA Martinez is rescinding the $500 civil penalty during today’s visit. Violation will be kept at a type A citation.

Upon arrival at todays visit, LPA Martinez saw the fire extinguisher with a service date of 04/26/2022. Plan of Correction was cleared in this visit.

Exit interview conducted. Report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2022
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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