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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607718
Report Date: 01/03/2022
Date Signed: 03/10/2022 03:04:02 PM

Document Has Been Signed on 03/10/2022 03:04 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:CENTINELA ASSISTED LIVING CENTREFACILITY NUMBER:
197607718
ADMINISTRATOR:GWENDOLYN CRAIGFACILITY TYPE:
740
ADDRESS:1000 S FLOWER STTELEPHONE:
(310) 674-3216
CITY:INGLEWOODSTATE: CAZIP CODE:
90301
CAPACITY: 96CENSUS: 53DATE:
01/03/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Gwen CraigTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Pamela Bunker, conducted an unannounced POC visit. LPA Bunker met with Administrator Gwen Craig. LPA Bunker informed staff that the purpose of today's visit was to ensure that the “B" deficiencies cited on 01/03/2022 during the Complaint visit dated 01/03/2022 control number 11-AS-20211230151609 was corrected as required and is now in compliance according to Title 22 Regulations.

We observed the following deficiency:

87303 (a) Maintenance and Operation:
Room #36 roof was repaired. The deficiency was corrected prior to today's visit.

The deficiencies initially cited have been corrected and cleared. Therefore, no civil penalties were assessed.

LPA Bunker provided staff with a letter of Deficiency Citations Cleared.
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2022
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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