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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609050
Report Date: 10/10/2023
Date Signed: 10/10/2023 12:48:29 PM


Document Has Been Signed on 10/10/2023 12:48 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: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: 0DATE:
10/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Dan Gormley/AdministratorTIME COMPLETED:
12:45 PM
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On 10/10/2023 Licensing Program Analysts LPA Alfonso Iniguez conducted an unannounced Case Management visit to the above facility. During visit LPA met with Dan Gormley/Regional Director of Operations and discussed the purpose of the visit is to serve a Decision and Order to the Administrator.

LPA delivered copy of the Decision and Order (CDSS #7923166013/Subject ID# 46000027385). The order to exclude Ruby Gean Bowie from any care facility licensed by the department is effective 10/02/2023. The order was provided to Administrator/Dan Gormley. Former Staff /Ruby Gean Bowie was not at the facility during the visit. Licensee stated he understands the Decision and Order and will not have Staff/Ruby Gean Bowie present since notified by CCL.

Exit interview conducted with Dan Gormley/Administrator
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2023
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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