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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802895
Report Date: 11/18/2024
Date Signed: 11/18/2024 01:10:53 PM

Document Has Been Signed on 11/18/2024 01:10 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ROSEMEAD HOMEFACILITY NUMBER:
197802895
ADMINISTRATOR/
DIRECTOR:		GUI-QIN ZONGFACILITY TYPE:
735
ADDRESS:3132 ROSEMEAD PLACETELEPHONE:
(626) 288-9346
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY: 6CENSUS: 3DATE:
11/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:59 PM
MET WITH:Guoliang Li, Administrator TIME VISIT/
INSPECTION COMPLETED:
01:16 PM
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LPA made unannounced visit to address Regional Center Recommendations. LPA met with Guoliang Li, Administrator and discussed the purpose of this visit.

LPA went over the recommendations one by one with Administrator and observed all the recommendations to have been complied with except the carpet being a safety hazard. LPA was also at home for Annual inspection and cited facility for the loose carpet on the annual inspection visit.

No deficiencies cited under this CM visit.

Exit interview and copy of report provided to Administrator.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2024
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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