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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606651
Report Date: 06/17/2023
Date Signed: 06/17/2023 11:42:39 AM

Document Has Been Signed on 06/17/2023 11:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:LAKEWOOD GARDENSFACILITY NUMBER:
197606651
ADMINISTRATOR:MARIE JEENE R DE CASTROFACILITY TYPE:
740
ADDRESS:12055 S. LAKEWOOD BLVD.TELEPHONE:
(562) 869-4038
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 150CENSUS: 72DATE:
06/17/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:43 AM
MET WITH:Jeenne De Castro - AdministratorTIME COMPLETED:
11:57 AM
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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced case management - annual continuation visit. LPA met with Jeenne De Castro (Administrator) and explained the reason for the visit. The initial annual visit was conducted on 06/06/2023.

During today's visit, the LPA completed the following CARE Tool domains: Planned Activities, Incidental Medical and Dental, and Residents with Special Health Needs. LPA interview 4 staff and 4 residents. LPA reviewed medication for 7 residents and observed that medications are documented properly and given as prescribed. LPA observed a menu and planned activities calendar for the month of June posted on the hallway wall.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during today's visit. Exit interview held and a copy of the report were provided to the Administrator.

Exit interview was conducted with Jeenne De Castro administrator and a copy of this report was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2023
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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