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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610204
Report Date: 08/13/2024
Date Signed: 08/13/2024 10:12:06 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/13/2024 10:12 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:STRATHERN STREET DIVINE HOMEFACILITY NUMBER:
197610204
ADMINISTRATOR/
DIRECTOR:		ADEFEMIWA, TOLUWALOPEFACILITY TYPE:
735
ADDRESS:19952 STRATHERN STREETTELEPHONE:
(818) 274-1809
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY: 4CENSUS: 0DATE:
08/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:18 AM
MET WITH:Prince Pius- tenantTIME VISIT/
INSPECTION COMPLETED:
10:12 AM
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Licensing Program Analysts (LPA) Leslie Ngo-Castaneda conducted an unannounced one (1) year required visit for this facility.

LPA arrived at 9:18 am. LPA met with individual tenant named Prince Pius. LPA informed the of the purpose of the visit. Tenant was not aware of the house being a facility since they have been renting for a year. LPA called licensee and was advised that facility could not be licensed by Regional Center. Licensee then is no longer interested keeping the facility open and wishes to cease operation.

A tour of the physical plant was conducted with the Licensee at 9:38 am. The facility has four (4) bedrooms and two (2) bathrooms. Facility is currently not occupied by clients, there are currently three (3) adult students and an infant living in the home. Facility has been absent of residents since August of 2023.

LPA advise licensee that license needs to be returned to RO.

LPA confirmed mailing address. Community Care Licensing will be mailing an official closure letter.

LPA reminded the Licensee/Administrator that if he or she should decide to reopen, then a new application with all the appropriate documents and fee shall be submitted to CCL and license approved before operation.

Exit interview conducted.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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