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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610112
Report Date: 11/02/2021
Date Signed: 11/02/2021 11:54:38 AM

Document Has Been Signed on 11/02/2021 11:54 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:CREBS COMPASSION HOMEFACILITY NUMBER:
197610112
ADMINISTRATOR:NASSANGA, FATUMAFACILITY TYPE:
735
ADDRESS:9343 BALCOM AVETELEPHONE:
(818) 324-9589
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 4CENSUS: 4DATE:
11/02/2021
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Moses BahingireTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the home in order to deliver findings for complaint number 31-AS-20190926110832. CREBS COMPASSION HOME/ 197609477 is no longer open and LPA came to this location as this is the new facility.. LPA was screened for COVID-19 symptoms before being allowed entry.

Upon entry, LPA toured the home with care staff and no health and safety concerns were observed during today's visit.

Exit interview conducted and report issued.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2021
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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