<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191640255
Report Date: 06/17/2021
Date Signed: 01/31/2022 04:10:52 PM

Document Has Been Signed on 01/31/2022 04:10 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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:FRANK'S ADULT RESIDENTIAL HOMEFACILITY NUMBER:
191640255
ADMINISTRATOR:EDWARD GOODSONFACILITY TYPE:
735
ADDRESS:1911 W. 137TH STREETTELEPHONE:
(310) 632-1213
CITY:COMPTONSTATE: CAZIP CODE:
90222
CAPACITY: 16CENSUS: 15DATE:
06/17/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:58 PM
MET WITH:Annette Evans, caregiverTIME COMPLETED:
01:59 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Ulysses Coronel conducted an unannounced POC visit. LPA spoke to administrator Edward Goodson the via telephone and the purpose of today’s visit was explained.

On 05/20/2021 LPA observed that the overhead lighting in 6 out of 10 bedrooms were in disrepair. Title 22 Regulations were cited, Proof of Correction was due on 06/03/2021 and an extension was requested and granted to complete corrections by 06/13/2021.

LPA and staff Annette Evans toured the physical plant. LPA observed that the overhead lighting in 6 out of 10 bedrooms were now operable.

Exit interview held. A copy of the report and clearance letter were provided to Annette Evans.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1