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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320430
Report Date: 07/18/2024
Date Signed: 07/18/2024 10:24:26 AM


Document Has Been Signed on 07/18/2024 10:24 AM - 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:AUNT MONA'S CARE HOMEFACILITY NUMBER:
198320430
ADMINISTRATOR:MONA MCCALLISTERFACILITY TYPE:
740
ADDRESS:2522 SUNNYSIDE RIDGE RDTELEPHONE:
(310) 721-9667
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90275
CAPACITY:6CENSUS: 5DATE:
07/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Sheryll Tilan - House ManagerTIME COMPLETED:
10:27 AM
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On 07/18/2024 Licensing Program Analyst (LPA) Mario Leon conducted a case management at the above-mentioned facility and was met by Sheryll Tilan, House Manager (S1).

S1 and Gregg MacEllven, Licensee, have spoken with LPA regarding the change of ownership which had been finalized on 05/28/2024.

No deficiencies were observed during today's visit.

An exit interview was held with Sheryll Tilan and a copy of this report was provided.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario LeonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2024
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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