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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320115
Report Date: 07/22/2024
Date Signed: 07/22/2024 03:18:16 PM


Document Has Been Signed on 07/22/2024 03:18 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:SAWTELLE ONE, LLCFACILITY NUMBER:
198320115
ADMINISTRATOR:BRENDA LEDEZMAFACILITY TYPE:
740
ADDRESS:4626/4630 SAWTELLE BLVDTELEPHONE:
(310) 301-8181
CITY:LOS ANGELESSTATE: CAZIP CODE:
90230
CAPACITY:6CENSUS: 0DATE:
07/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Staff - Micheal SaucedoTIME COMPLETED:
03:30 PM
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On 7/22/2024 at around 3:10 PM Licensing Program Analyst (LPA), Leandro conducted an unannounced finial walk through to the facility mentioned above. LPA met with staff, Micheal Saucedo and explained the purpose of the visit.

LPA did not observe any residents in the facility.

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: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2024
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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