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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320157
Report Date: 03/14/2024
Date Signed: 03/14/2024 03:11:39 PM

Document Has Been Signed on 03/14/2024 03:11 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:NASHARI RESIDENTIAL CAREFACILITY NUMBER:
198320157
ADMINISTRATOR:CLARKE, ZOIEFACILITY TYPE:
735
ADDRESS:10779 CAPISTRANO AVENUETELEPHONE:
(310) 627-9208
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY: 4CENSUS: 4DATE:
03/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator/Licensee - CLARKE, ZOIETIME COMPLETED:
03:30 PM
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On 03/14/2024 at around 1:00 PM, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Licensee/Administrator Zoie Clarke. LPA explained the purpose of the visit and was accompanied by a staff member inside and outside the facility during this inspection.

This facility is licensed to serve 4 adults ages 18 – 59 years, of which 2 may be non-ambulatory clients.

A total of 3 ambulatory and 1 non-ambulatory clients are currently residing in this facility.

Due to time constraints, LPA was unable to complete annual inspection.

No deficiencies are being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22.

An exit interview was conducted and a copy of this report was left with the Licensee.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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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