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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610449
Report Date: 10/24/2024
Date Signed: 10/24/2024 12:49:46 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/24/2024 12:49 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:EXCELLENCE COMMUNITY RESIDENTIAL PROPERTIES 2FACILITY NUMBER:
197610449
ADMINISTRATOR/
DIRECTOR:		ASKEW, OCTAVIAFACILITY TYPE:
735
ADDRESS:4369 PORTOLA DRTELEPHONE:
(424) 789-0439
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 4CENSUS: 0DATE:
10/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Octavia WatkinsTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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LPA Spaeth conducted an unannounced visit and was greeted by the Administrator, Octavia Watkins. The Administrator stated there are no residents at the facility. LPA toured the facility and observed there are no clients living at the facility at this time.

Exit interview conducted, and a copy of the report was given.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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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