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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610351
Report Date: 03/19/2025
Date Signed: 03/19/2025 01:49:22 PM

Document Has Been Signed on 03/19/2025 01:49 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:GIG HOMESFACILITY NUMBER:
197610351
ADMINISTRATOR/
DIRECTOR:		JOHNSON, OLUWAROTIMIFACILITY TYPE:
735
ADDRESS:40035 CHALFONT CTTELEPHONE:
(310) 503-1777
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 4CENSUS: 0DATE:
03/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:22 AM
MET WITH:Babashola Babatunde and George AyoariyoTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) LPA Melissa Spaeth conducted an unannounced visit and was greeted by the Licensee and a staff member. LPA Spaeth stated the purpose of the visit was to conduct an unannounced annual visit. The Licensee stated there are no residents living in the facility and is still awaiting approval from the Regional Center.

LPA Spaeth toured the facility at 9:45 am until 10:05 am. LPA observed the living room and dining room are combined and contained a dining room table, dining room chairs, and comfortable seating with a television in the living room area. The kitchen was clean and the knives were locked in a kitchen cabinet. The bathrooms contained hand soap, paper towels, and a trash can.

The backyard is shaded and contain comfortable seating. The gate leading from the backyard to the front yard was not locked.

There are four bedrooms which contained a bed, linens, a chair and chest of drawers. LPA Spaeth did not observe any clients in the facility.

There are no deficiencies to report. Exit interview conducted, and a copy of the signed report was given.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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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