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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608044
Report Date: 09/14/2021
Date Signed: 09/15/2021 11:18:37 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: 85DATE:
09/14/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:53 PM
MET WITH:Yvette LemTIME COMPLETED:
04:09 PM
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On 09/14/2021 at around 2:00pm Licensing Program Analyst (LPA) Ulysses Coronel a case managementvisit and met with Yvette Lem, the administrator and the purpose of the visit was explained.

During todays visit LPA observed that the facility's is conducting symptom screenings and records the visitors contact information at the entrance. LPA also observed the activity directors pushing an activity cart towards the facility's memory care unit. The activity director Deshante Fuqua stated that they were going to play bingo at the memory care side and will go to the assisted living side afterwards to do bingo. During todays visit LPA observed that the facility had an activity calendar for the month of September posted on the hallway.

An exit interview was conducted a copy of this report was provided to the administrator.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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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