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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600558
Report Date: 02/02/2023
Date Signed: 02/02/2023 03:19:49 PM

Document Has Been Signed on 02/02/2023 03:19 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:PALS EINDELIJK EL MONTEFACILITY NUMBER:
198600558
ADMINISTRATOR:GLORIA GALLEGOSFACILITY TYPE:
775
ADDRESS:11645 MCBEAN DR.TELEPHONE:
(626) 279-1064
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY: 60CENSUS: 40DATE:
02/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Program Manager Zeke MezaTIME COMPLETED:
03:30 PM
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Licensing Program Analyst's (LPA'S) Glenn Trueman and Erik Zaragoza made an unannounced visit to the facility and explained the reason for the visit.
The purpose of the visit is to follow up on the SOC 341 submitted by the facility in regards to staff slapping a client.
Interview was conducted with Program Manager Zeke Meza at 1:50 P.M.
Files for Client C1 and Client C2 were reviewed.
ID page, IPP and Physician's Report for C1 were submitted.
ID page and Physician's Report were submitted for C 2.
File was reviewed for Staff S 1. Personnel Record for S 1 was submitted.
Interviews were conducted with Staff S 2 and S 3 at 2:30 P.M.
City Of El Monte Police Department Case # 23-003267 submitted at visit.

Due to insufficient information available at this time, the above allegation needs further investigation.

Exit interview conducted and copy provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2023
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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