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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
401700013
Report Date:
05/14/2021
Date Signed:
05/14/2021 02:04:16 PM
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. #250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
ATASCADERO CHRISTIAN HOME
FACILITY NUMBER:
401700013
ADMINISTRATOR:
CHRIS WOHLWEND
FACILITY TYPE:
740
ADDRESS:
8455 SANTA ROSA ROAD
TELEPHONE:
(805) 466-0281
CITY:
ATASCADERO
STATE:
CA
ZIP CODE:
93422
CAPACITY:
64
CENSUS:
38
DATE:
05/14/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
08:57 AM
MET WITH:
Chris Wohlend/Administrator
TIME COMPLETED:
01:58 PM
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SUPERVISOR'S NAME:
Kelly Burley
TELEPHONE:
(805) 562-0413
LICENSING EVALUATOR NAME:
Mark Jeffries
TELEPHONE:
(805) 635-4718
LICENSING EVALUATOR SIGNATURE:
DATE:
05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/14/2021
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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