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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204540
Report Date: 03/27/2023
Date Signed: 03/27/2023 02:39:38 PM


Document Has Been Signed on 03/27/2023 02:39 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:VILLA MIRAGE INC.FACILITY NUMBER:
198204540
ADMINISTRATOR:YOLANDA LEEFACILITY TYPE:
740
ADDRESS:2655 BARRY AVENUETELEPHONE:
(310) 479-2984
CITY:LOS ANGELESSTATE: CAZIP CODE:
90064
CAPACITY:6CENSUS: 0DATE:
03/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:12 PM
MET WITH:Youlanda LeeTIME COMPLETED:
03:00 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
On 03/27/23, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced case management visit for facility closure. LPA met with Licensee Yolanda Lee, and explained the purpose of todays visit.

LPA and Licensee toured the facility and checked all the rooms. During the walk through, LPA observed no residents or belongings. All rooms are being packed up and cleaned. All equipment is being removed, packed up and picked up.

Final walk through shows there are no residents and closure is in its final stages.

LPA conducted a final interview and a copy of this report was provided to Licensee.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023
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