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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601613
Report Date: 10/19/2023
Date Signed: 04/16/2024 01:08:09 PM

Document Has Been Signed on 04/16/2024 01:08 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:WILMINGTON GARDENSFACILITY NUMBER:
191601613
ADMINISTRATOR:FLORES,V.ANDT.FACILITY TYPE:
735
ADDRESS:1311 WEST ANAHEIM STREETTELEPHONE:
(310) 835-6366
CITY:WILMINGTONSTATE: CAZIP CODE:
90744
CAPACITY: 48CENSUS: DATE:
10/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH: Administrator Vic Jun FloresTIME COMPLETED:
11:30 AM
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On 10/19/23, Licensing Program Analyst (LPA) Lizeth Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Vic Jun Flores and explained the purpose of today’s visit. The facility is licensed to operate for forty-eight (48) ambulatory mentally disabled adults ages 18-59. Rooms #1 and 2 cleared for mechanical aids. Current census is 43.

The facility is two buildings next to each other with one side being two stories and the other side being a one story horseshoe of rooms. The facility is located in a residential neighborhood. It consists of the following: 25 client bedrooms, 12 full bathrooms, three (3) storage rooms, activity room, office, lobby, side patio, shaded area front patio, kitchen, dining room, outdoor activity area, laundry room and a parking lot.

LPA arrived to the facility and began reviewing resident records; however was unable to complete annual visit as the facility is currently being treated by pest control. LPA will return at a later day to complete the inspection.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023
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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