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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320232
Report Date: 04/18/2024
Date Signed: 04/18/2024 01:40:40 PM

Document Has Been Signed on 04/18/2024 01:40 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:REM CALIFORNIA, LLC - E 213THFACILITY NUMBER:
198320232
ADMINISTRATOR/
DIRECTOR:		PAGE, LATORIFACILITY TYPE:
735
ADDRESS:1356 E 213TH STTELEPHONE:
(562) 912-7710
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 4CENSUS: 3DATE:
04/18/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:49 AM
MET WITH:Robyn Hood & Martel PlotnickTIME VISIT/
INSPECTION COMPLETED:
12:39 PM
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On 04/18/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced Proof of Correction (POC) visit. LPA Dabuet met with Program Supervisor Robyn Hood and Program Director Martel Plotnick. LPA Dabuet informed staff that the purpose of today's visit was to ensure that the type "B" deficiency cited on 03/27/24 during an Annual Inspection visit was corrected as required and is now in compliance according to Title 22 Regulations. LPA Dabuet reviewed/audited personnel records for staff Martel Plotnick and Helen Workneh and determined the files are complete with the required documents.

The deficiency initially cited on 03/27/24 - 80066(a)(c) - Personnel Records has been cleared and corrected. Therefore, no civil penalties were assessed. LPA Dabuet provided staff with a letter of Deficiency Citations Cleared and LIC 809 Facility Evaluation Report.

There were no deficiencies cited.

An exit interview conducted with Martel Plotnick and a copy of this report is provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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