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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610652
Report Date: 06/02/2026
Date Signed: 06/02/2026 02:51:24 PM

Document Has Been Signed on 06/02/2026 02:51 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:CHRISTIAN ANGELFACILITY NUMBER:
197610652
ADMINISTRATOR/
DIRECTOR:		KAYIIRA, MARGARET NFACILITY TYPE:
735
ADDRESS:3931 SADDLE DRIVETELEPHONE:
(661) 383-3822
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 4CENSUS: 1DATE:
06/02/2026
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
01:35 PM
NARRATIVE
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On 05/26/2026 at 10:10 a.m., Licensing Program Analyst (LPA) Huma Rahimi, conducted a Plan of Correction (POC) follow-up visit regarding citations issued during Complaint Investigation No. 31-AS-20260504153935, conducted on 05/12/2026.

Upon arrival, LPA met with Resident #1 (R1), who granted access to the facility and contacted the Administrator by telephone. LPA attempted to explain the purpose of the visit; however, the Administrator refused to discuss the matter, became agitated regarding the LPA's presence at the facility, and terminated the call.

During the visit, LPA observed that R1 was alone in the facility without care and supervision. LPA also verified that R1 is a participant of the Department of Mental Health. During the visit, Community Health Worker Donnie Harvey from the Department of Mental Health arrived at the facility. Mr. Harvey informed LPA that efforts were underway to identify and secure an appropriate placement for R1.

LPA also retrieved a Department-issued laptop charger that had inadvertently been left at the facility during the initial compliant visit conducted on 05/12/2026.

Continue on LIC 809C

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Huma Rahimi
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CHRISTIAN ANGEL
FACILITY NUMBER: 197610652
VISIT DATE: 06/02/2026
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Citation: Section 80065(a) – Personnel Requirements - As part of the approved Plan of Correction, the Administrator agreed to relocate R1 and submit relocation information to the Department by the POC due date of 05/13/2026. The Administrator also agreed not to admit any clients or residents until the facility became vendored by the North Los Angeles County Regional Center (NLACRC). At the time of today's visit, the correction had not been completed and the POC had not been cleared. LPA observed that R1 continued to reside at the facility without care and supervision.

Citation: Section 80022(j) – Plan of Operation - As part of the approved Plan of Correction, the Administrator agreed to relocate R1 and submit relocation information to the Department by the POC due date of 05/19/2026. The Administrator also agreed not to admit any clients or residents until the facility became vendored by the North Los Angeles County Regional Center (NLACRC).

At the time of today's visit, the correction had not been completed and the POC had not been cleared. LPA observed that R1 remained in the facility without care and supervision.

Based on observations made during the POC follow-up visit, the facility failed to implement the corrective actions outlined in the Plans of Correction for Sections 80065(a) and 80022(j). Both deficiencies remain uncleared.

The Administrator was not present at the facility and no staff were available during the visit. Therefore, there was no facility representative available to review or sign the Licensing Report and associated deficiency notices. Copies of the reports will be provided to the Administrator via the Department's approved delivery method.

Deficiencies issued during today's visit.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Huma Rahimi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 06/02/2026 02:51 PM - It Cannot Be Edited


Created By: Huma Rahimi On 06/02/2026 at 11:41 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CHRISTIAN ANGEL
FACILITY NUMBER: 197610652

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/03/2026
Section Cited
CCR
80065(a)

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80065(a) Personnel Requirements (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement is not met as evidenced by:
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On 05/12/26 the Administrator agreed to relocate R1 and R1's relocation information will be submitted to LPA by the POC duet date. And further agreed not accept any clients/resident until they are vendored by the North Los Angeles County Regional Center (NLACRC).
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Based on LPA's observations during today's visit, the licensee failed to ensure adequate staffing and supervision to meet Resident #1's needs and failed to implement the approved Plan of Correction requiring Resident #1's relocation.
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LPA observed Resident #1 alone at the facility without care and supervision. This poses an immediate health and safety risk to the resident in care.
Type B
06/09/2026
Section Cited
CCR80022(j)

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80022(j) Plan of Operation. Any changes in the plan of operation which affect the services to clients shall be subject to licensing agency approval and shall be reported as specified in Section 80061 - Reporting Requirements.
This requirement is not met as evdenced by:
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On 05/12/26 the Administrator agreed to relocate R1 and R1's relocation information will be submitted to LPA by the POC duet date. And further agreed not accept any clients/resident until they are vendored by the North Los Angeles County Regional Center (NLACRC).
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Based on LPAs' observation during today's visit, licensee failed to enure staffing in accordance with the approved plan of operation to have 24 care and supervision for residents in care which poses/posed a potential health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Huma Rahimi
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/02/2026 02:51 PM - It Cannot Be Edited


Created By: Huma Rahimi On 06/02/2026 at 12:39 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CHRISTIAN ANGEL
FACILITY NUMBER: 197610652

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/03/2026
Section Cited
CCR
80078(a)

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80078 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the client's needs.

This requirement is not met as evidenced by:
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The Administrator shall coordinate with the Department of Mental Health and all appropriate parties to relocate Resident #1 to a placement that can meet the resident's care and supervision needs. Until relocation occurs, the Administrator
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Based on LPA's observation during today's visit, R1 was observed alone at the facility without care and supervision. The licensee failed to ensure that care and supervision were provided as necessary to meet R1's needs. This poses an immediate health and safety risk to the resident in care.
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shall ensure that qualified staff are present to provide care and supervision at all times. Documentation verifying the resident's relocation and updated placement information shall be submitted to Licensing by the Plan of Correction due date.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Huma Rahimi
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2026


LIC809 (FAS) - (06/04)
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