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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607034
Report Date: 12/14/2021
Date Signed: 12/14/2021 04:32:22 PM

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:CARDINAL YU-PIN MANORFACILITY NUMBER:
197607034
ADMINISTRATOR:KUN HUFACILITY TYPE:
740
ADDRESS:15602 BELSHIRE AVENUETELEPHONE:
(562) 926-1289
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:49CENSUS: 24DATE:
12/14/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Kun Wendy Hu TIME COMPLETED:
04:45 PM
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Licensing Program Analysts (LPAs) Nicol Wesley and Bonnie Tao conducted an unannounced case management inspection and met with Administrator Kun Wendy Hu and explained the purpose for todays visit. Prior to the visit, a risk assessment was completed. The facility phone number is 562 926 1289.

During todays visit, LPA Wesley and Tao toured the physical plant, and interviewed a random selection of residents. There were no health and safety concerns observed. During the visit Accountant Julie Chen arrived and joined the visit and discussed the completion of the TSP(Technical Support Program) engagement services that was completed as of 11/23/21.

There were no deficiencies cited.

A copy of this report was given during the exit interview.

Exit interview conducted.
SUPERVISOR'S NAME: Rebecca OrendainTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021
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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