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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600235
Report Date: 07/06/2023
Date Signed: 07/06/2023 12:49:04 PM

Document Has Been Signed on 07/06/2023 12:49 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:ULTIMATE CARE 11FACILITY NUMBER:
198600235
ADMINISTRATOR:COLLETTE JOHNSON RAMIREZFACILITY TYPE:
735
ADDRESS:601 CENTER STREETTELEPHONE:
(310) 640-8686
CITY:EL SEGUNDOSTATE: CAZIP CODE:
90245
CAPACITY: 6CENSUS: 3DATE:
07/06/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:12 PM
MET WITH:Yvana Reyes-AdministratorTIME COMPLETED:
12:48 PM
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On 7/6/2023 Licensing Program Analyst LPA Alfonso Iniguez conducted an unannounced POC visit for the facility above. LPA meet with Yvana Reyes and the reason of the visit was explained to her.
Licensee requested and extension for citation regarding window frame. LPM Eva Alvarez grated a 4 week extension to repair window frame. LPA Iniguez received POC from other citations and cleared it while he was in the facility.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time.

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to the Administrator/Yvana Reyes.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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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