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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198203004
Report Date: 11/20/2024
Date Signed: 11/20/2024 04:00:00 PM

Document Has Been Signed on 11/20/2024 04:00 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:GOLDEN SEASONSFACILITY NUMBER:
198203004
ADMINISTRATOR/
DIRECTOR:		CESAR FELICIANOFACILITY TYPE:
740
ADDRESS:1116 CERISE AVENUETELEPHONE:
(310) 320-7178
CITY:TORRANCESTATE: CAZIP CODE:
90503
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
11/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Administrator - Bien CadungogTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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On 11/20/2024, the California Department of Social Services (CDSS) – Community Care Licensing Division (CCLD) staff conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Administrator, Bien Cadungog. CCLD staff explained the purpose of the visit and was accompanied by a staff member inside and outside the facility during this inspection.

The facility is licensed to serve 6 adults ages 60 and above. All bedrooms are cleared for bedridden residents. The facility has a waiver for a maximum 1 resident at a time.

The facility currently has 3 residents.

The facility has Annual Licensing Fees due on 12/18/2024 of $495.
Ulysses CoronelTELEPHONE: (323) 981-1755
Socorro LeandroTELEPHONE: 323-981-1755
DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GOLDEN SEASONS
FACILITY NUMBER: 198203004
VISIT DATE: 11/20/2024
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The facility is a one-story house located in a residential street. The home consists of 4 resident bedrooms, 1 staff bedroom, 2 full bathrooms, 1 entry room area, 1 dining room area, 1 living room area, 1 kitchen area with laundry area, 1 de-attached garage, and 1 backyard patio area with shaded seating.

Due to insufficient time CCLD staff was unable to complete annual inspection.

No deficiencies were cited.

An exit interview was conducted, and a copy of this report was left with the Administrator.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC809 (FAS) - (06/04)
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