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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801142
Report Date: 04/25/2024
Date Signed: 04/25/2024 04:07:22 PM


Document Has Been Signed on 04/25/2024 04:07 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:CHRISTIAN'S HOME FOR THE ELDERLYFACILITY NUMBER:
565801142
ADMINISTRATOR:MARIA C. CARTERFACILITY TYPE:
740
ADDRESS:3066 SCHOOL STREETTELEPHONE:
(805) 526-4715
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:6CENSUS: 0DATE:
04/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Maria CarterTIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced Case Management-Other visit to the above facility. LPA met with Administrator, Maria Carter as the purpose of the visit is to conduct a final walk-through of the facility prior to closure. Entrance interview conducted.

On 12/21/2023, the Administrator visited the Regional Office in Woodland Hills to inform the Department of the intent to close the facility. On 11/27/2023, the facility notified and issued written notices to two (2) residents residing at the facility. As of January 31, 2024, both residents have relocated to their personal homes with family.

During today’s visit, LPA observed facility to be vacant and verified that no care and supervision was being provided. Administrator, Maria Carter surrendered License to LPA Arroyo. The facility will be closed effective April 25, 2024, in the Licensing Information System (LIS).

Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2024
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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