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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320478
Report Date: 02/19/2025
Date Signed: 02/19/2025 04:41:14 PM

Document Has Been Signed on 02/19/2025 04:41 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:AVOCET AT PLAYA VISTAFACILITY NUMBER:
198320478
ADMINISTRATOR/
DIRECTOR:		MCGEVNA, KEITH MFACILITY TYPE:
741
ADDRESS:12490 FIELDING CIRCLETELEPHONE:
(424) 216-7788
CITY:PLAYA VISTASTATE: CAZIP CODE:
90094
CAPACITY: 286CENSUS: 213DATE:
02/19/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:20 PM
MET WITH:Executive Director Keith McGevnaTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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On 02/19/2025, Community Care Licensing Division (CCLD) Staff conducted a case management - other visit at the above facility. CCLD Staff met with the Executive Director Keith McGevna and explained that the purpose of the visit was to investigate complaint 11-AS-20250212123219. During the investigation, the facility was unable to provide the signal system call log reports to CCLD. The facility was also unable to provide the reports on the case management - incident visit on 02/07/25.

A Technical Violation is hereby issued. According to Title 22, Division 6, Chapter 8, Article 13, The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours (see LIC9102).

An exit interview was conducted and a copy of this report was left with the Executive Director Keith McGevna.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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