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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197801459
Report Date: 06/29/2022
Date Signed: 06/29/2022 02:50:35 PM

Document Has Been Signed on 06/29/2022 02:50 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:CASA SAHAGUN NUESTRO REFUGIOFACILITY NUMBER:
197801459
ADMINISTRATOR:GUADALUPE E. SAHAGUNFACILITY TYPE:
735
ADDRESS:14136 BRONTE DRIVETELEPHONE:
(562) 945-5530
CITY:WHITTIERSTATE: CAZIP CODE:
90602
CAPACITY: 6CENSUS: 4DATE:
06/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Guadalupe Sahagun, AdministratorTIME COMPLETED:
02:55 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
Licensing Program Analyst (LPA) Galarza conducted a case management visit and met with Licensee Guadalupe Sahagun. The scope of today’s visit is for the purpose of a request for capacity decrease from six (6) bed spaces to four (4) bed spaces. The facility is licensed to serve Developmentally Disabled Clients (ages 18 through 59 years). The fire safety inspection clearance was granted by LA County Fire Department Inspector E. Martinez effective 6/28/2022.

It consists of 6 bedrooms [3 designated for clients and 6 for family use], living room, family room, dining room, kitchen, laundry room, weight training room, covered backyard deck area, and gated self-latching swimming pool. The office room in the attached garage is presently being used as an additional bedroom #7 for licensee's family member.

On February 4, 2022, the Eastern Los Angeles Regional Center provided a capacity decrease support letter. The last annual inspection was conducted today. One (1) deficiency was observed, but the capacity decrease will be granted from six (6) to four (4).

A new facility license with the capacity change will be mailed to Licensee. Ms. Sahagun was informed that the old license will be void.

An exit interview was conducted with Licensee/Administrator Guadalupe Sahagun. A copy of the report was issued.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
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