<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608044
Report Date: 01/26/2021
Date Signed: 01/27/2021 09:56:19 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:NISHITH MODIFACILITY TYPE:
740
ADDRESS:3540 MARTIN LUTHER KING, JR.TELEPHONE:
(310) 638-4113
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:178CENSUS: 106DATE:
01/26/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nishith ModiTIME COMPLETED:
10:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 01/26/2021 Assistant Program Administrator Claire Matsushita, Regional Manager Benita Yates, Licensing Program Manager Janae Hammond, Licensing Program Analyst Ulysses Coronel, Facility Representative Dr. Jasvant Modi, Administrator Nishith Modi and Caregiver Supervisor Patricia Garcia conducted a conference call, the purpose of the call is to discuss the Departments concerns with the facility's daily operations. During todays meeting the following was discussed:
  • Administrative Oversight of the facility
  • Staffing concerns
  • Reporting Requirements

Dr. Modi agreed to do the following in order to bring the facility into compliance no later than 01/27/2021.

  1. Update the staffing schedule.
  2. Review/update line list with Licensing on 01/27/2021.

The facility was informed that failure to comply may result in the department seeking administrative actions.


A hard copy of this report was provided via email for signature.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1