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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601607
Report Date: 08/02/2024
Date Signed: 08/02/2024 01:04:37 PM

Document Has Been Signed on 08/02/2024 01:04 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:SENASAC HOUSEFACILITY NUMBER:
191601607
ADMINISTRATOR/
DIRECTOR:		LATASHIA HAMMONDFACILITY TYPE:
735
ADDRESS:3748 SENASACTELEPHONE:
(562) 421-3889
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 6CENSUS: 4DATE:
08/02/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Vice President - Mary ArtmanTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 08/02/2024 at around 11:40 AM Licensing Program Analyst (LPA) Socorro Leandro arrived to the facility mentioned above. LPA met with Vice President Mary Artman and explained the purpose of the visit.

LPA delivered an amendment to a deficiency cited on 08/01/2024.
Deficiency regarding Acceptance and Retention Limitations for Client 1.
Client 1 was diagnosed with Alzheimer & Dementia in 2023 and then again in 2024.

An exit interview was conducted, and a copy of this report and deficiency was left with the Vice President along with their Appeal Rights.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2024
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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