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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191222631
Report Date: 09/05/2024
Date Signed: 09/24/2024 01:45:23 PM

Document Has Been Signed on 09/24/2024 01:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:NELVILLE GUEST HOMEFACILITY NUMBER:
191222631
ADMINISTRATOR/
DIRECTOR:		HERMINIA DELACRUZFACILITY TYPE:
735
ADDRESS:2005 E. ORANGE GROVE BLVD.TELEPHONE:
(626) 791-1170
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY: 6CENSUS: 0DATE:
09/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:42 PM
MET WITH:Glorie Pascasio - Co-AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:00 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) Bennette Pena conducted an unannounced subsequent required 1-year visit. The initial visit was conducted on 09/05/2024. Upon arrival, LPA observed a city building permit notification on the front of the facility window. No one answered the door, LPA contacted the Administrator Herminia de la Cruz who directed me to contact Glorie Pascasio. At 1:05pm, LPA was met by Administrator Glorie Pascasio and explained the purpose of the visit. The facility is licensed to serve six (6) developmentally disabled clients 18-59 years old.

Presently, the facility is undergoing major renovations. Currently, there are zero (0) clients under care and supervision and zero (0) staff working at the facility. LPA and the Administrator toured the facility inside and out. Administrator stated that the facility has (4) client bedrooms, (2) bathrooms, kitchen, living room, dining area, storage room, office area, laundry area, backyard and detached garage. LPA observed construction debris in and around the facility, Due to safety concerns, LPA concluded the required 1-yr visit. Additionally, the facility is not providing care for any clients at this time, nor staff present during the renovation. There are no deficiencies to address at this time. Licensee notified CCLD of the construction and remodel on 07/11/2023.

Exit interview was conducted and a copy of this report was provided to Administrator Glorie Pascasio.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
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