<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197800744
Report Date: 08/18/2021
Date Signed: 08/18/2021 03:23:02 PM

Document Has Been Signed on 08/18/2021 03:23 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CASITAS ESPERANZAFACILITY NUMBER:
197800744
ADMINISTRATOR:JOSE GOMEZFACILITY TYPE:
772
ADDRESS:11925 1/4,1/2 11931 ELLIOTT AVTELEPHONE:
(626) 350-5304
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY: 13CENSUS: 12DATE:
08/18/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jose GomezTIME COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Trueman conducted a Case Management visit for the purpose of observing the rooms that the facility plans to use for clients for facility's request for increase in capacity. Casitas Esperanza is currently licensed for 12 ambulatory clients. Facility would like to increase capacity from 12 to 13 clients.

Facility has added House # 4 which facility plans to use for the additional client.
LPA toured the facility with Administrator Jose Gomez which included House # 3,4, 8 and 9.
In House # 3, 8 and 9 each bedroom has 2 twin size beds. LPA observed that the beds have the required linen, dresser, television, a night stand with a lamp, 2 chairs, a closet, and there is a bathroom in the bedroom. All rooms are equipped with smoke detectors.

The other bedroom in House #4 which facility plans to use for the increase has 1 twin size bed. LPA observed that the bed has the required linen, a night stand with a lamp, television, 2 chairs and closet space. The smoke detector was tested and is working properly.

There is a carbon monoxide detector located in the living room in all buildings.

Physical Plant meets requirements.

Exit interview conducted.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1