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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610743
Report Date: 03/10/2025
Date Signed: 03/10/2025 11:55:18 AM

Document Has Been Signed on 03/10/2025 11:55 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:MAYALL HOMEFACILITY NUMBER:
197610743
ADMINISTRATOR/
DIRECTOR:		ANDRES, CHARMILEYFACILITY TYPE:
735
ADDRESS:19638 MAYALL ST.TELEPHONE:
(714) 519-8997
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 4CENSUS: 4DATE:
03/10/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Frank Barragan- House Manager TIME VISIT/
INSPECTION COMPLETED:
12:05 PM
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Licensing Program Analysts (LPAs) Mariana Agban and Michael Cava conducted an unannounced Case Management visit to the facility. The purpose of today’s visit was to serve the Order of Immediate Exclusion from the Facility for Staff #1 (S1)

On today's visit LPAs met with House Manager, Frank Barragan and explained the reason for the visit. House Manager was served an Immediate Exclusion Order for Staff #1(S1). No immediate Health and Safety Hazard was noted during this visit.

Exit interview held. A copy of the report was provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
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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