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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320147
Report Date: 11/13/2024
Date Signed: 11/13/2024 03:59:10 PM

Document Has Been Signed on 11/13/2024 03:59 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:ICAN CALIFORNIA ABILITIES NETWORK LONG BEACHFACILITY NUMBER:
198320147
ADMINISTRATOR/
DIRECTOR:		CLAIRE ROAFACILITY TYPE:
775
ADDRESS:4200E.PACIFIC COAST HWY.STE200TELEPHONE:
(310) 374-8295
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY: 18CENSUS: 15DATE:
11/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:47 PM
MET WITH:Rebecca Flores, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
04:03 PM
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On 11/13/2024 The Department of Social Services, Community Care Licensing Division (CCLD) staff conducted a case management visit at the above-mentioned facility. CCLD staff was met by Rebecca Flores, program manager (S1), and the purpose of the visit was explained. CCLD staff and S1 toured the facility and the facility was observed as clean and in good repair during the visit.

There have been zero (0) deficiencies cited during today's visit.

An exit interview was held with, Rebecca Flores (S1), and a copy of this report was provided.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2024
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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