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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607689
Report Date: 11/21/2024
Date Signed: 11/21/2024 02:27:06 PM

Document Has Been Signed on 11/21/2024 02:27 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:AMERICARE ASSISTED LIVING OF ROLLING HILLSFACILITY NUMBER:
197607689
ADMINISTRATOR/
DIRECTOR:		EDNA DIMALANTAFACILITY TYPE:
740
ADDRESS:4826 ROCKBLUFF DR.TELEPHONE:
(310) 422-5364
CITY:ROLLING HILLS ESTATESTATE: CAZIP CODE:
90274
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
11/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:47 PM
MET WITH:Leia Joaquin, LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:37 PM
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On 11/21/24 The Department of Social Services, Community Care Licensing Division (CCLD) staff conducted an unannounced case management visit to the above-mentioned facility (this facility). The purpose of the visit was explained to Leia Joaquin, Licensee (S4).

While CCLD staff was on-site, CCLD staff observed one (1) staff member (S3) not currently associated to this facility. CCLD staff reviewed the Facility Personnel Report and found that S3 is not associated to this facility. CCLD staff interviewed four (4) staff (S1-S4).

Interviews revealed that all four (4) staff have agreed that one staff (S3) has not been associated to this facility.

One Technical Violation has been provided, please see LIC9102AN.

An exit interview was held with Leia Joaquin, Licensee, and a copy of this report has been provided.
Ulysses CoronelTELEPHONE: (323) 981-1755
Mario LeonTELEPHONE: (323) 981-1755
DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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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