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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606963
Report Date: 08/30/2022
Date Signed: 08/30/2022 02:50:30 PM


Document Has Been Signed on 08/30/2022 02:50 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:HOLY CARE HOME CENTER, INCFACILITY NUMBER:
197606963
ADMINISTRATOR:JAYSON SANDHUFACILITY TYPE:
740
ADDRESS:2709 CENTRAL AVENUETELEPHONE:
(626) 443-8993
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY:30CENSUS: 3DATE:
08/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jasmen SandhuTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Assistant Administrator Jasmen Sandhu and explained the reason for the visit.
Shortly there after Administrator Jayson Sandhu arrived.
The purpose of visit is to check on the status regarding closure of the facility.
Letter had been submitted to Licensing which stated that the facility will close on 08/31/2022.
Also received document listing 21 residents to be relocated and 60 days notices to residents and authorized reps.
Facility had been communicating with Licensing regarding status of residents. As of 08/25/2022 there were 6 residents to be relocated.
As of today's visit 3 residents are still residing at the facility and will be relocated 08/31/2022.
LPA along with Administrator toured the facility which included resident rooms, restrooms, kitchen area and backyard area.
LPA observed in Building 2 Resident # 1, Building 3 Resident #2 and Building 4 Resident #3.
In Buildings 27151/2, 2709 and 2708 no residents were living there and no furniture or resident belongings were observed.
Administrator stated that Resident's # 1-3 will be relocated to licensed facility on 08/31/2022.

Exit interview conducted and copy provided.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn TruemanTELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2022
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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