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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 12:48:48 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:
12:39 PM
MET WITH:Dan Gormley/AdministratorTIME COMPLETED:
12:40 PM
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On 10/10/2023 Licensing Program Analyst, LPA/Alfonso Iniguez conducted a Case Management/Facility Closure visit at this facility. LPA was met by Dan Gormley/Regional Operations Director who allowed for LPA's entry to the facility. LPA informed Dan the purpose of the visit is to conduct a final walk-through and to retrieve the Department of Social Services Community Care License.

LPA conducted a tour of the entire facility with Administrator. During the inspection, LPA observed the following: main lobby, theater room, activity room, dining and kitchen area, laundry area, medication room and open courtyard area, 1st, and 2nd floor rooms. LPA did not observe any clients residing at the facility. LPA did not observe any food supplies during the inspection. Terraza Cheviot Hills submitted a closure plan to the Department on 6/29/2023, indicating the closure effective date of 10/9/2023.

On 10/10/2023 Dan Gormley voluntarily surrendered Terraza Cheviot Hills license to The Department of Social Services Community Care License LPA Iniguez. Effective 10/10/2023 will no longer hold a licensed to operate from Community Care Licensing.

According to the California Code of Regulations (Title 22, Division 6, Chapter 1), LPA did not observed deficiencies; therefore, no citations are issued.

An exit interview was conducted with Cecelia Cade and a hard copy was provided to 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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