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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197610011
Report Date:
11/02/2021
Date Signed:
02/13/2023 11:46:33 AM
Document Has Been Signed on
02/13/2023 11:46 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:
MASCHELLE VILLA
FACILITY NUMBER:
197610011
ADMINISTRATOR:
MONJE-DU, CHERY
FACILITY TYPE:
740
ADDRESS:
25577 ALMENDRA DRIVE
TELEPHONE:
(661) 425-7500
CITY:
VALENCIA
STATE:
CA
ZIP CODE:
91355
CAPACITY:
6
CENSUS:
DATE:
11/02/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
10:40 AM
MET WITH:
Attempted Visit
TIME COMPLETED:
11:15 AM
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SUPERVISORS NAME
:
Nichelle Gillyard
LICENSING EVALUATOR NAME
:
Shira Stamps
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/02/2021
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/02/2021
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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