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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600093
Report Date: 07/23/2024
Date Signed: 07/23/2024 02:29:22 PM

Document Has Been Signed on 07/23/2024 02:29 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:BAY BREEZE CAREFACILITY NUMBER:
191600093
ADMINISTRATOR/
DIRECTOR:		DIMATULAC, RODOLFOFACILITY TYPE:
735
ADDRESS:1653- 55 SANTA FE AVETELEPHONE:
(562) 432-8033
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY: 76CENSUS: 61DATE:
07/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:11 PM
MET WITH:Administrator - Rodolfo DimatulacTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 07/23/2024 Licensing Program Analyst (LPA), Leandro met with Administrator, Rodolfo Dimatulac and conducted a tour of the facility.

LPA observed that the bathroom in the second floor of the mens building is under construction.

Administrator explained that the facility is currently renovating all of their facility bathrooms. He explained that all facility bathrooms will be renovated by the end of the year.

LPA observed contract between the facility and construction company to renovate facility bathrooms.

Licensee will email plan of renovations to their assigned LPA.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE: DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2024
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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