<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850347
Report Date: 12/18/2024
Date Signed: 12/18/2024 11:37:42 AM

Document Has Been Signed on 12/18/2024 11:37 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:MOM'S PLACE 3FACILITY NUMBER:
565850347
ADMINISTRATOR/
DIRECTOR:
IBIRONKE, YUSUFFACILITY TYPE:
740
ADDRESS:975 VALLEY VISTA DRIVETELEPHONE:
(818) 274-1809
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
12/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit. Upon arrival, the facility appeared vacant. LPA contacted the Back-up Administrator, Laila Kulungu via telephone and at this time, the reason for the visit was explained. Back-up Administrator stated that staff Howard Suanes will be present during today's visit and gave authorization to sign today's report. Licensee was unable to come during today's visit. At 11:00 A.M. The LPA met with staff Howard Suanes. Reason for the visit was explained. LPA was informed by Back-up Administrator and staff that currently the facility is going to be renovated. Entrance interview.

LPA and staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations.

The following was observed. At the time of the visit, no residents were observed. The licensee is preparing to remodel this facility. LPA did not observed any any structural change/addition or renovation being done at the moment. The staff stated the facility currently has no residents as the facility is undergoing a remodel.

At 11:15 A.M., smoke and carbon monoxide detectors were tested and operational at the time of the visit.

Back-up Administrator stated the facility will retain their license but will not admit residents until the property has been fully remodeled and all safety checks have been completed. Back-up Administrator agreed to inform the licensing department when all work is completed, and facility will resume with admissions.



Exit interview conducted. Report was reviewed and issued.
Desaree PereraTELEPHONE: (818) 596-4347
Valeria ConwayTELEPHONE: (818) 454-0485
DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1