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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600259
Report Date: 04/12/2023
Date Signed: 04/18/2023 10:34:06 AM

Document Has Been Signed on 04/18/2023 10:34 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:SOCIAL VOCATIONAL SERVICES, LB INCLUSION CTR.FACILITY NUMBER:
198600259
ADMINISTRATOR:SERAFIN AVILAFACILITY TYPE:
775
ADDRESS:530 EAST WARDLOW ROADTELEPHONE:
(562) 424-7322
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY: 18CENSUS: 18DATE:
04/12/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:LIzette Cortes TIME COMPLETED:
11:15 AM
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On 04/12/23 Licensing Program Analyst( LPA) Ernand Dabuet initiated a Collateral visit at this day program. LPA met with Program Director Lizette Cortes . LPA explained the purpose of this visit is to gather information regarding a current complaint about ACOSTA FAMILY HOME II Complaint number 11-AS-20230406123315.

The investigation visit consisted of interviews with client #1 (C1) and client (C3) both who currently reside as consumers at Acosta Family Home II #198320282. Details of the interviews are documented on LIC 812 crossed reference with Acosta Family Home II.

An exit interview was conducted with Lizette Cotes, and a hard copy was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2023
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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