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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015952
Report Date: 02/26/2021
Date Signed: 02/26/2021 02:27:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:BETHANY MANOR DEVELOPMENT AND LEARNING CENTERFACILITY NUMBER:
198015952
ADMINISTRATOR:RENEE KOSKAFACILITY TYPE:
850
ADDRESS:15415 S. PIONEER BLVD.TELEPHONE:
(562) 868-1517
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:64CENSUS: DATE:
02/26/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Renee Koska, DirectorTIME COMPLETED:
03:00 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
Due to COVID-19 and precautionary measures, this inspection was conducted with Director Renee Koska via tele-inspection by the use of FaceTime. The purpose of this Case Management tele-inspection is to discuss the Decision and Order dated February 26, 2021 for her George Chavarria; and to deliver the Decision and Order dated February 26, 2021 via email to Director/licensee. During this tele-inspection, LPA discussed Decision and Order and it was stated by Director that the individual George Chavarria has not been employed or present in the facility for more than two years.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Licensee, via tele-inspection, during which appeal rights were explained. This report along with a copy of the appeal rights will be sent to the Applicant via email with a read receipt or confirmation of receipt of email, which will act as the Applicants signature.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021
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