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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608511
Report Date: 10/24/2022
Date Signed: 10/24/2022 09:57:20 AM

Document Has Been Signed on 10/24/2022 09:57 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:CASA BLANCA HOMECAREFACILITY NUMBER:
197608511
ADMINISTRATOR:MARILOU A. ANDREASFACILITY TYPE:
740
ADDRESS:17216 GOYA STREETTELEPHONE:
(818) 366-2234
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 4CENSUS: 0DATE:
10/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Marilou Andreas/ AdministratorTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Patrick Shanahan, arrived at the facility and was greeted by the facility administrator. There are no residents at the location at this time. The LPA did have his temperature taken and Covid -19 protocol was followed.

The inspection tool was used to complete the annual. No deficiencies or issues were observed during the visit.

Exit Interview conducted and report issued.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2022
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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