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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320037
Report Date: 01/16/2025
Date Signed: 01/17/2025 11:52:48 AM

Document Has Been Signed on 01/17/2025 11:52 AM - 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:CARMIE HOME CAREFACILITY NUMBER:
198320037
ADMINISTRATOR/
DIRECTOR:		RECIO, PAOLOFACILITY TYPE:
735
ADDRESS:14528/30 HALLDALE AVETELEPHONE:
(310) 938-2190
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY: 9CENSUS: 7DATE:
01/16/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:58 PM
MET WITH:Rosauro Deguzman, CaregiverTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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On 1/16/25, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual at the facility listed above. LPA arrived at facility and explained the purposed of the visit was to review documents for Annual and was granted access to the facility.

LPA Felisa Shirley spoke to facility administrator and reviewed facility records.

Due to the time of day, LPA will return on another day to complete this annual.

An exit interview was conducted with Administrator, Paolo Recio and a copy of this report was provided.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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