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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610655
Report Date: 02/19/2025
Date Signed: 02/19/2025 11:41:37 AM

Document Has Been Signed on 02/19/2025 11:41 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:CHRISTIAN ANGELFACILITY NUMBER:
197610655
ADMINISTRATOR/
DIRECTOR:		MEGGSKAYIIRA@GMAIL.COMFACILITY TYPE:
735
ADDRESS:22323 BARBACOA DRIVETELEPHONE:
(661) 383-3822
CITY:SANTA CLARITASTATE: CAZIP CODE:
91350
CAPACITY: 4CENSUS: 0DATE:
02/19/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Margaret KayiiraTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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This report was transferred over from the LIC809 dated 01/16/2025 for facility #197610652 where it was erroneously placed.
Licensing Program Analysts (LPAs) Nadia Shahbazian and Abeye Duguma conducted a Pre-Licensing
Inspection with the Margaret Kayiira/administrator at 10:00am. An application to operate an Adult Residential Facility (ARF) was received by Community Care Licensing (CCL) on 05/24/2024. A fire clearance was approved on 06/17/2024 for four (4) ambulatory residents, for a total capacity of four. The smoke alarms and carbon monoxide detectors are dual and inter-connected. The facility has a fire extinguisher purchased on 06/30/2024. Fire extinguisher is located in the kitchen.

With the assistance of the administrator, a tour of the physical plant was initiated at 10:30am and the following was observed:
KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, stove/oven, microwave oven and dishwasher. There was an adequate supply of non-perishable food items observed. Perishable food items not required at this time as there are no residents. Administrator was advised facility needs to carry perishable food items once they admit residents for care. Knives were observed locked in a kitchen drawer. Cleaning supplies observed locked in the garage cabinet.

BEDROOMS: There are four (4) private bedrooms, three bedrooms will be used for residents and one bedroom for staff. Bedroom two (2) will be utilized as the staff bedroom. Each bedroom was furnished with beds, chairs, dresser drawer and closets, bedding and linen. The bedrooms have sufficient lighting. Bedroom one (1) is near the entry door and had two closets.


(CONT. on LIC809-C)
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CHRISTIAN ANGEL
FACILITY NUMBER: 197610655
VISIT DATE: 02/19/2025
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BATHROOMS: The facility has two (2) bathrooms. Bedroom #1 has it's own bathroom with shower. The
other bathroom is located by bedrooms three (3) and four (4). The bathrooms were observed to have the proper fixtures and had adequate supply of linens and hygiene items. Hot water delivered in the bathrooms measured between 117.8 degrees.

COMMON AREAS: These include den, living room and dining room areas. The living room has a couch, chair, table, and television. There is a fireplace in the living room, properly screened and there were no fireplace tools present. The dining room has a table large enough to seat six (6) residents.

LAUNDRY ROOM: The laundry area is located in the garage. Cleaning supplies and chemicals were kept in the garage, locked in cabinets, inaccessible to potential residents.

MEDICATIONS: Medications will be kept locked in a kitchen cabinet. There were two first aid kits, both locked in the kitchen cabinet.

SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction.
The backyard of the facility is large enough to hold outdoor activities. There was appropriate backyard furniture and were located underneath a covered patio. There is no swimming pool. A fire pit with covered lid was observed in the backyard. There are no cameras in the facility. There are two (2) side gates leading to the backyard, free of obstruction and both exits could be used for emergency entry/exit.


OFFICE/STAFF WORKSTATION: Staff workstation/office is located in the kitchen. The work-station consists of two filing cabinets to store resident and staff records, and a work desk. Facility is equipped with internet access and land line telephone.

In addition to the Pre-Licensing inspection, a Component III power point presentation was also held. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to
be compliant and ready for licensure. CAB will be advised and a copy of this report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC809 (FAS) - (06/04)
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