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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606622
Report Date: 12/01/2024
Date Signed: 12/01/2024 03:48:02 PM

Document Has Been Signed on 12/01/2024 03:48 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:STANWIN RESIDENTIAL CAREFACILITY NUMBER:
197606622
ADMINISTRATOR/
DIRECTOR:		MARY JANE C. MONTIANOFACILITY TYPE:
735
ADDRESS:9768 STANWIN AVENUETELEPHONE:
(747) 225-0382
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY: 6CENSUS: DATE:
12/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:05 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Abeye Duguma arrived to the facility at around 3:00p.m. There was Ring doorbell on the property. LPA knocked on the door multiple times but to no avail. LPA made several attempts to reach the licensee by phone (818) 322-6534 and (747) 225-0382, no answer. LPA left business card at the door.

Nothing further at this time.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2024
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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