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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197803516
Report Date: 03/05/2024
Date Signed: 03/05/2024 03:55:46 PM


Document Has Been Signed on 03/05/2024 03:55 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:STONEGATE GUEST HOMEFACILITY NUMBER:
197803516
ADMINISTRATOR:EMELITA ALANGUIFACILITY TYPE:
740
ADDRESS:1170 CHISOLM TRAIL DR.TELEPHONE:
(909) 861-3856
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY:6CENSUS: 0DATE:
03/05/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:33 PM
MET WITH:Eugene Alangui, AdministratorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted a case management visit due to facility closure. LPA met with Licensee/Administrator, Eugene Alangui, and explained the purpose of the visit.

On 3/5/24, the licensee contacted the Monterey Park office to inform of the facility closure. LPA conducted a visit to ensure residents have moved out of the facility. During the visit today, LPA verified that all the residents have moved out of the facility. LPA also collected the original license.

An exit interview was held. A copy of this report was given to Eugene Alangui.
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024
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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