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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610310
Report Date: 12/18/2024
Date Signed: 12/18/2024 10:28:09 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/18/2024 10:28 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:HODGES HOMES INC.FACILITY NUMBER:
197610310
ADMINISTRATOR/
DIRECTOR:		KING, MARLONFACILITY TYPE:
735
ADDRESS:37137 CANNON CTTELEPHONE:
(661) 860-4425
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY: 4CENSUS: DATE:
12/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
10:35 AM
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On 12/18/2024 at approximately 9:45 AM, Licensing Program Analyst (LPA) Angelica Segovia attempted to conduct a one (1) year required annual visit at this facility. Upon arrival, LPA rang the doorbell to no answer. AT 10:00 AM LPA called the Administrator at phone number: (661) 860-4425 and left a voicemail stating the reason for the visit. Shortly after the Administrator called back informing LPA that she was out of town until next week. Another visit will be done for the annual.

Copy of this report left in mailbox.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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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