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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593367
Report Date: 11/30/2021
Date Signed: 11/30/2021 03:08:39 PM

Document Has Been Signed on 11/30/2021 03:08 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:HUMAN SERVICES ASSOCIATIONFACILITY NUMBER:
191593367
ADMINISTRATOR:DARREN DUNAWAYFACILITY TYPE:
775
ADDRESS:6800 FLORENCE AVE.TELEPHONE:
(562) 806-5400
CITY:BELL GARDENSSTATE: CAZIP CODE:
90201
CAPACITY: 40CENSUS: 0DATE:
11/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Office Manager Laura AvilaTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit and was greeted by Office Manager Laura Avila and explained the reason for the visit.
The purpose of the visit is to complete the required inspection.
This Adult Day Program currently is closed and has not been operating as of March 2020.
LPA Trueman toured the facility along with Office Manager Laura Avila today 11/30/2021 at 1:20 PM and the following was observed:
Staff Offices
Alzheimer's Day Care Resource Center (ADCRC) Room with tables and chairs.
Kitchen Area
Client's Restrooms
Conference Room
Outdoor Patio

No deficiencies

Exit interview conducted
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2021
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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