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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320468
Report Date: 01/31/2025
Date Signed: 01/31/2025 10:22:24 AM

Document Has Been Signed on 01/31/2025 10:22 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:QUINCY MANORFACILITY NUMBER:
198320468
ADMINISTRATOR/
DIRECTOR:		CHAVEZ, JOSIEFACILITY TYPE:
735
ADDRESS:113-115 N. CHESTER AVE.TELEPHONE:
(310) 635-9959
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 12CENSUS: 12DATE:
01/31/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:37 AM
MET WITH:Administrator Josie ChavezTIME VISIT/
INSPECTION COMPLETED:
10:22 AM
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On 01/31/25 Licensing program analyst (LPA) Villegas conducted a case management visit relating to the initial pre-licensing (CHOW) visit that was conducted on 01/17/24. LPA met with Administrator Josie Chavez.

The following items were observed to be corrected
-required furniture in client bedrooms (1) chair per client.
-obtain and place living room furniture in back house
-Ensure bedroom windows and window screens are clean and it good repair
-Personnel files- Each staff should have completed and documented the required training's for title 22 regulations as well as all training's listed on the plan of operations.
-update facility sketch to show Jack and Jill bathroom between bedrooms #6 and #7.

Component III was conducted at the case management visit, information provided about how to operate the facility within substantial compliance.

An exit interview was conducted and a copy of this report has been furnished to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025
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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