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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320235
Report Date: 12/23/2021
Date Signed: 12/23/2021 12:04:50 PM

Document Has Been Signed on 12/23/2021 12:04 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
CCLD Regional Office, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:REM CALIFORNIA, LLC - OCANAFACILITY NUMBER:
198320235
ADMINISTRATOR:MURRAY, MARSHAFACILITY TYPE:
735
ADDRESS:3839 OCANA AVE.TELEPHONE:
(562) 354-6589
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 3CENSUS: DATE:
12/23/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Marsha Murray TIME COMPLETED:
11:38 AM
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Component II completion: Successful

Facility Type: ARF
Application Type: CHOW
Capacity:3
Census (if any clients in care): 2
COMP II Participants: Marsha Murray
Interview Method: Telephone interview

On 12/23/21 , applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained.

During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas:
1. Facility operation: License type, client/resident populations, and program
2. Admission Policies
3. Staffing requirements & Training
4. Restrictive/Prohibited Health Conditions
5. General provisions
6. Emergency Preparedness
7. Complaints & Reporting
8. Pre-licensing readiness

Schedule for Ocana
20 hours in each home.
Tues/Thurs 8 hours each day
Fridays 4 hours

Park Street
2 clients currently in care
Friday 4 hours
Monday 8 hours Wednesday 8 hours
SUPERVISORS NAME: Mirella Quaranta
LICENSING EVALUATOR NAME: Susan Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2021
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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