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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607987
Report Date: 03/04/2021
Date Signed: 03/08/2021 02:45:18 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:LA MIRADA VILLA FOR THE ELDERLYFACILITY NUMBER:
197607987
ADMINISTRATOR:FLORINDA P. QUIZONFACILITY TYPE:
740
ADDRESS:15005 LA FONDA DRIVETELEPHONE:
(714) 228-9133
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY:6CENSUS: 4DATE:
03/04/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee Florinda P QuizonTIME COMPLETED:
11:30 AM
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This case management visit was conducted via virtual meeting to discuss a possible change of ownership.
Present in this meeting: Araceli Ramirez (Regional Manager for Monterey Park Office);Jose Villalobos (Licensing Program Analyst), Eliza De Honor (Administrator), Florinda P Quizon (Licensee).

On todays meeting:
It was addressed in the meeting that the Department was made aware, on 2/28/21, by the licensee that she is no longer in control of property and involved in the day to day operations of the facility. Florinda stated that she is still the licensee and involved in the day to day operations. Florinda stated that she does not have a rental agreement with Eliza for the property. She still has control of property. Licensing was informed that the current administrator is Eliza De Honor. Licensee stated she had not sent in the required administrator documentation into Licensing. Florinda stated she would send in all required administrator documents via priority mail to licensing by 3/8/2021.

During this meeting the Change of Ownership process was also explained and discussed. Administrator Eliza De Honor stated she is going to submit the application for change of ownership into licensing by 3/9/21. Licensee Florinda stated she understood that licenses are not transferable and that she is still responsible for the facility until Eliza completes her application process. Florinda agreed to send LPA Villalobos a copy of the draft notice that will be sent out to the residents responsible parties by 3/12/21

The following Title 22 Regulation Sections were discussed and materials will be provided via email;
  • Eviction Procedures 87224 (RCFE)
  • H&S Code 1569.682
  • H&S Code 1569.191
  • PIN 18-17-ASC Facility Closure Requirements
  • Reporting Requirements 87211 (RCFE)
Exit Interview conducted with Licensee Florinda and copy of this report emailed for signature.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2021
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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