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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609050
Report Date: 09/27/2023
Date Signed: 09/27/2023 11:02:02 AM


Document Has Been Signed on 09/27/2023 11:02 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:TERRAZA OF CHEVIOT HILLSFACILITY NUMBER:
197609050
ADMINISTRATOR:DOINA STEPHANIE RADUFACILITY TYPE:
740
ADDRESS:3340 SHELBY DRTELEPHONE:
(310) 837-9181
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY:100CENSUS: 7DATE:
09/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:59 AM
MET WITH:Sam Gormley/Regional Director of OperationsTIME COMPLETED:
11:00 AM
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On 9/27/2023 Licensing Program Manager (LPM) Eva Alvarez and Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced Case Management visit. Upon arriving at the facility, LPM and LPA met with Veronica Sevilla/Activity Director and later with Dan Gormley/Regional Director of Operations who assisted with the visit. LPA explained the purpose of today's visit is to check on the closure of the facility, relocation of former residents and the remaining residents at the facility.

LPM, LPA and activity director conducted a physical tour of the facility. Currently the facility census is: 7; A total of 36 residents have moved already to other facilities (information about where the residents moved can be found in the weekly tracker). During this visit LPA obtained a copy of the resident roster, staff schedule and weekly menu.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time.



An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Dan Gormley/Regional Director of Operations.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023
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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