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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609704
Report Date: 08/16/2022
Date Signed: 08/16/2022 02:49:25 PM

Document Has Been Signed on 08/16/2022 02:49 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:SAFE LAUREL LLCFACILITY NUMBER:
197609704
ADMINISTRATOR:GBOYEGA AKINBOLAFACILITY TYPE:
735
ADDRESS:16300 VINTAGE STTELEPHONE:
(818) 489-1218
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 4CENSUS: 0DATE:
08/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:TIME COMPLETED:
02:06 PM
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LPA attempted to conduct a one-year infection control visit. To gain entry to the facility, LPA rang doorbell and knocked at the door several times with breaks in between, but to no avail. LPA was unable to reach the Administrator via telephone number listed on FAS (818) 489-1218. No other contact information on file. LPA looked through the windows and did not see or hear any activity in the home. No cars in the drive way and facility has delivery boxes at the front door.

No further action at this time.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2022
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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