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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608072
Report Date: 07/06/2021
Date Signed: 07/08/2021 03:44:48 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:EVERGREEN SENIOR CAREFACILITY NUMBER:
197608072
ADMINISTRATOR:EVANGELINA REYESFACILITY TYPE:
740
ADDRESS:528 HOWARD STREETTELEPHONE:
(626) 284-0503
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY:14CENSUS: 12DATE:
07/06/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Licensee, Jason LiangTIME COMPLETED:
04:45 PM
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An informal conference was held on 7/6/21 via Microsoft Teams. The purpose of this meeting was to discuss the possible change of ownership.

Participants in this meeting were Lisa Hicks (Licensing Program Manager), Cynthia Chan (Licensing Program Analyst), and Jason Liang (Licensee).

On 6/24/21, the licensee informed LPA of selling of property and potential new ownership. The following Title 22 Regulations were discussed and materials were provided to the licensee:
  • Reporting Requirements 87211
  • Eviction Procedures 87224
  • Health & Safety Code 1569.682
  • Health & Safety Code 1569.191
  • PIN 18-17-ASC (Facility Closure Requirements)

The licensee was made aware of the required items to be approved by CCL prior to completing the closure which includes a closure plan, eviction notice, and submission of an application from the prospective buyer. Licensee is also aware that he will continue to hold responsibility and to remain in compliance with all regulations until the transition is completed.

Per Mr. Liang, the proposed closure plan and eviction notice will be submitted to LPA by close of business on 7/15/21.

An exit interview was conducted and a copy of this report was emailed for a signature.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
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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