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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608788
Report Date: 02/08/2023
Date Signed: 02/08/2023 11:30:53 AM


Document Has Been Signed on 02/08/2023 11:30 AM - 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 BELLA MARFACILITY NUMBER:
197608788
ADMINISTRATOR:SHAWN C. MOONEYFACILITY TYPE:
740
ADDRESS:825 OCEAN AVETELEPHONE:
(310) 393-5258
CITY:SANTA MONICASTATE: CAZIP CODE:
90403
CAPACITY:36CENSUS: 3DATE:
02/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Anita ScukardiTIME COMPLETED:
11:45 AM
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On 2/8/23 Licensing Program Analyst (LPAs) Antonine Richard and David Espana conducted a Case Management - Other Visit to the above facility. The purpose of the visit is to ensure that the facility remains in compliance with Title 22 Regulations. During todays visit the team were assisted by Administrator Anita Csukardi with a tour of the inside and outside of the facility.

During todays visit the team observed that the facility was clean, sanitary and in good repair. The facility had sufficient food supply, and there were sufficient staff of (5) providing care and supervision to the residents of (3). No deficiencies were cited.

An exit interview was conducted an a copy of this report was provided.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Antonine RichardTELEPHONE: (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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