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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607966
Report Date: 01/15/2025
Date Signed: 01/15/2025 05:54:56 PM

Document Has Been Signed on 01/15/2025 05:54 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:VETERANS HOME OF CALIFORNIA - WEST LOS ANGELESFACILITY NUMBER:
197607966
ADMINISTRATOR/
DIRECTOR:		DEVON YOUNGFACILITY TYPE:
740
ADDRESS:11500 NIMITZ AVENUETELEPHONE:
(424) 832-8200
CITY:LOS ANGELESSTATE: CAZIP CODE:
90049
CAPACITY: 84TOTAL ENROLLED CHILDREN: 0CENSUS: 60DATE:
01/15/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:36 PM
MET WITH:Aithi Hong- Assurance & Compliance ManagerTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On January 15, 2025, Licensing Program Analyst Alfonso Iniguez conducted an unannounced case management visit. The LPA met with Aithi Hong, the Assurance and Compliance Manager, to explain the purpose of the visit.

The department issued a Decision and Order against (S#1), effective January 13, 2025. During the visit, LPA Iniguez confirmed that (S#1) was not working or associated with the facility. He spoke with Edward, the Human Resources Manager, who stated that they received the notice on January 14, 2025, and that (S#1) would be disassociated from Guardian as of January 15, 2025. Additionally, Aithi Hong provided LPA Iniguez with a copy of the current LIC 500 Personnel Report, which did not include (S#1). It is also important to note that (S#1) was officially terminated on December 17, 2023.

During this visit LPA did not observe deficiencies therefore no citations were issued at this time.


An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Aithi Hong/Assurance & Compliance Manager.

Eva M AlvarezTELEPHONE: (323) 629-7047
Alfonso IniguezTELEPHONE: 323-981-1755
DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
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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