197801344-11-6-2024-28-AS-EZAA-DARPPG-20241106102931

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197801344
Report Date: 08/27/2024
Date Signed: 11/06/2024 10:30:27 AM

Document Has Been Signed on 11/06/2024 10:30 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	VICTORIA HOME		FACILITY NUMBER:	197801344
ADMINISTRATOR/ DIRECTOR:	MARIA ALVARADO		FACILITY TYPE:	735
ADDRESS:	14002 MANSA DRIVE		TELEPHONE:	(562) 921-0543
CITY:	LA MIRADA	STATE: CA	ZIP CODE:	90638
CAPACITY: 4	TOTAL ENROLLED CHILDREN: 0	CENSUS: 3	DATE:	08/27/2024
TYPE OF VISIT:	Office	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Maria Alvarado - Licensee/Administrator		TIME VISIT/ INSPECTION COMPLETED:	11:10 AM

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	An informal conference meeting ws conducted today 8/27/2024 via Microsoft Teams. The purpose of this informal office meeting was to discuss the coming facility Change in Ownership (CHOW) for the Facility Victoria Home #197801028. Present i nthis meeting: Licensing Program Analyst (LPA) Erik Zaragoza, Licensing Program Manager (LPM) David Sicairos, East Los Angeles Regional Center (ELARC) representatives Cristina Monterrosa and Doris Weis, as well as the Licensees for the facility Maria Alvarado and Jose Alvarado. The Following Title 22 Regulations and Health & Safety Codes were discussed, and materials provided during the meeting. Documents will also be emailed to the Licensees Maria and Jose: - H&S Code 1524.1 Sale of licensed community care facility resulting in issuance of new license; conditions; exemptions - Title 22 80034 Submission of New Application - Title 22 80068.5 Eviction Procedures Maria explained that she was seeking a CHOW due to her coming retirement, along with the fact that the clients of the home have lived in the facility for many years and do not want to be relocated to another facility. Therefore Maria is seeking to sell the business to a new Licensee/Administrator named Melanie who has previous experience working as an administrator in an Adult Residential Facility (ARF), and Maria plans to rent out the property to Melanie following the CHOW. Maria Alvarado wanted to confirm that this type of CHOW would be possible as she would like to continue to own the property. Continued on LIC 809-C

David Sicairos	TELEPHONE: (323) 981-3982
Erik Zaragoza	TELEPHONE: (323) 981-3983
	DATE: 08/27/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VICTORIA HOME	FACILITY NUMBER: 197801344
	VISIT DATE: 08/27/2024

NARRATIVE

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LPM David Sicairos explained the application process to all parties present in the meeting. It was advised that Maria and Jose will need to contact the Centralized Application Bureau (CAB) in order to initiate the CHOW, and will be finalized after the LPA conducts the Pre-Licensing visit at the facility. It was also advised that Maria and Jose will remain the licensees of the facility and responsible for its day-to-day operations until the CHOW application process is completed and approved. Residents and families (responsible parties) should be given advance notice of the CHOW as well, notifying them of the change of ownership, and copies of the letters should be sent to the department.

LPM Sicairos and LPA Zaragoza requested that the licensees mail a sixty (60) day written notice of their intent to sell the business to the new licensee/administrator Melanie and to contact CAB in order to begin the application process for the CHOW.

An exit interview was conducted, and a copy of this report was provided to Licensees Maria Alvarado and Jose Alvarado.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024

LIC809 (FAS) - (06/04)

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