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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608044
Report Date: 07/27/2021
Date Signed: 08/04/2021 08:28:05 AM

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:VISTA VERANDA ASSISTED LIVINGFACILITY NUMBER:
197608044
ADMINISTRATOR:YVETTE LEMFACILITY TYPE:
740
ADDRESS:3540 MARTIN LUTHER KING, JR.TELEPHONE:
(310) 638-4113
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:178CENSUS: 87DATE:
07/27/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Yvette LemTIME COMPLETED:
09:45 AM
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On 07/27/2021 at 9:00 am Licensing Program Manager (LPM) Janae Hammond and Licensing Program Analyst (LPA) Ulysses Coronel conducted an office meeting with Licensee Representatives Dr, Jasvant Modi, Kinal Modi, Bhavin Modi, Nishith Modit and administrator Yvette Lem. To follow-up on concerns discussed during the conference call conducted on 07/13/2021.

The following items were discussed:
Administrators office
Administrator access to facility and resident records.
PPE Inventrory.
Staffing Updates.
Memory Care Residents relocation
Residents P&I Ledgers format.
Census Increase request.

Follow-up Items:
Written consents from residents responsible parties regarding relocation.
Census increase documents.

Another meeting will be held by the end of August 2021.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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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