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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608787
Report Date: 02/08/2023
Date Signed: 02/08/2023 12:58:07 PM


Document Has Been Signed on 02/08/2023 12:58 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:MERIDIAN AT OCEAN VILLAFACILITY NUMBER:
197608787
ADMINISTRATOR:SHAWN C MOONEYFACILITY TYPE:
740
ADDRESS:413 OCEAN AVETELEPHONE:
(310) 393-0242
CITY:SANTA MONICASTATE: CAZIP CODE:
90402
CAPACITY:36CENSUS: 4DATE:
02/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:58 AM
MET WITH:Anita CsukardiTIME COMPLETED:
01:15 PM
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On 02/08/23 Licensing Program Analyst (LPA) David España and Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced Case Management visit to this facility with LPAs and Program Director, Anita Csukardi. Deficiencies were not observed during today's visit. Title 22 Regulations are not being cited. Water temperature check in room 4 was observed: 105.2F.
An exit interview was conducted.
A copy of this report was provided to Anita Csukardi.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023
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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