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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320329
Report Date: 09/26/2024
Date Signed: 09/26/2024 03:13:21 PM

Document Has Been Signed on 09/26/2024 03:13 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:DALTON CARE HOMES, INC.FACILITY NUMBER:
198320329
ADMINISTRATOR/
DIRECTOR:		QUAN, MARIAFACILITY TYPE:
735
ADDRESS:16015 S. DALTON AVENUETELEPHONE:
(310) 714-6537
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY: 6CENSUS: 5DATE:
09/26/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:16 PM
MET WITH:Administrator Melonie Joy SuarezTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On September 26, 2024 Licensing Program Manager (LPM) Ulysses Coronel and Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced Case Management-Deficiencies.. LPA and LPM were greeted by MarkLuther Corcillesand granted access to the facility. Administrator Melonie Joy Suarez, subsequently arrived and the purpose of the visit was discussed.

The purpose of this visit is to document deficiencies observed during the investigation of a complaint with complaint control number 11-AS-20240923092045. On 09/26/2024, 1 out of 6 staff present, S1 did not have their criminal record clearance associated to the facility.

Title 22, Division 6,Chapter 1,Article 03. Application Procedures is being cited, please see attached LIC809D.

An exit was conducted, and plans of corrected was developed with the administrator. A copy of this report and the appeals rights was provided.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 09/26/2024 03:13 PM - It Cannot Be Edited


Created By: Deborah Lee On 09/26/2024 at 02:26 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: DALTON CARE HOMES, INC.
FACILITY NUMBER: 198320329

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
10/08/2024
Section Cited
CCR
80019(e)(3)

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Criminal Record Clearance All individuals subject to a criminal record review ... shall prior to working, residing or volunteering in a licensed facility:Request a transfer of a criminal record clearance as specified in Section 80019(f). This requirement was not met as evidenced by:
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During today's visit S1 clearance was associated to the facility. The administrator agreed to create a plan to ensure future compliance.
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Based on interviews and record reviews. The licensee did not ensured that S1 criminal record clearance was tranferred to the facility prior to working at this facility. Which poses a potential health & safety and personal rights risk to clients in care.
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Violation of Section 80019(e) will result in an immediate assessment of civil penalties of one hundred dollars ($100) per violation for a maximum of 5 days by the Department

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Eva M Alvarez
LICENSING EVALUATOR NAME:Deborah Lee
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2024


LIC809 (FAS) - (06/04)
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