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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421700369
Report Date: 04/12/2024
Date Signed: 04/12/2024 05:05:29 PM


Document Has Been Signed on 04/12/2024 05:05 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:ATTERDAG VILLAGE OF SOLVANGFACILITY NUMBER:
421700369
ADMINISTRATOR:CHRIS PARKERFACILITY TYPE:
741
ADDRESS:636 N ATTERDAG ROADTELEPHONE:
(805) 688-3263
CITY:SOLVANGSTATE: CAZIP CODE:
93463
CAPACITY:188CENSUS: 160DATE:
04/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Julie Driscoll, Social Services DirectorTIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Miller arrived at 9:45 a.m. to conduct a one-year annual visit to the facility above. LPA met with Julie Driscoll, Social Services Director and explained the purpose of the visit.

LPA will need additional time to complete the annual visit.



Exit interview conducted and copy of report printed for Administrator.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Erika MillerTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2024
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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