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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 567610007
Report Date: 03/14/2024
Date Signed: 03/14/2024 10:13:02 AM


Document Has Been Signed on 03/14/2024 10:13 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:VARENITA OF SIMI VALLEYFACILITY NUMBER:
567610007
ADMINISTRATOR:VEIS, MARGIEFACILITY TYPE:
740
ADDRESS:3921 COCHRAN STREETTELEPHONE:
(805) 327-1100
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:110CENSUS: 100DATE:
03/14/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Margie VeisTIME COMPLETED:
10:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced case management – other visit at 9:00 a.m. The purpose of this visit is to obtain pertinent information regarding an incident that occurred on 01/01/2024. Upon arrival, LPA met with the Marketing Director. The Executive Director (ED), Margie Veis, arrived during the visit. Entrance Interview.

During today’s visit, LPA Arroyo met with one staff member at 9:18 a.m., conducted a record review, and obtained copies of pertinent documents.

Exit interview conducted. Report was reviewed and a copy was issued.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2024
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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