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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593149
Report Date: 01/16/2025
Date Signed: 01/16/2025 09:53:25 AM

Document Has Been Signed on 01/16/2025 09:53 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:HARVEST HOUSEFACILITY NUMBER:
191593149
ADMINISTRATOR/
DIRECTOR:		LIESS, CAROLFACILITY TYPE:
735
ADDRESS:14029 HARVEST AVENUETELEPHONE:
(562) 484-0320
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 8CENSUS: 0DATE:
01/16/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Otilio Renzon Construction WorkerTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA Gutierrez was met by construction worker Otilio Renzon at approximately 9:00 AM and explained reason for visit. Multiple attempts to contact Administrator Carol Liess were unsuccessful.

Facility is licensed to serve eight (8) developmentally disabled adults, ages 18-59. The facility is in a residential area, and it is a one-story family home. LPA observed the house to be under full remodel. LPA was allowed entry and toured the home with construction worker. An 812 on 10/24/2024 was created by LPM Lisa Hicks with a plan of relocation of clients to Home for Life Foundation and Cedar Street Home. No Files were available to review.

No deficiency was observed during today’s visit. Exit interview was conducted and a copy of report was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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