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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600673
Report Date: 05/07/2024
Date Signed: 05/07/2024 05:03:48 PM

Document Has Been Signed on 05/07/2024 05:03 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:HARVEST RESIDENTIAL CARE HOMEFACILITY NUMBER:
198600673
ADMINISTRATOR/
DIRECTOR:
FABIAN, SHIELA ANAFACILITY TYPE:
735
ADDRESS:16302 HARVEST AVENUETELEPHONE:
(323) 469-3432
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 4CENSUS: 4DATE:
05/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Samuel Bachillar/ Sheila FabianTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced Required 1 year inspection at the facility and met with Samuel Bachillar and explained the purpose for todays visit. During the visit Sheila Ann Fabian arrived and joined the visit. The facility phone number is 562 924 3465.

The facility consist of four resident bedrooms, one staff bedroom, two bathrooms, a living room, den, office area, dining room, kitchen, a detached garage, an an outside area patio area for shade.

LPA Wesley conducted a complete tour of the facility, and observe the supply of food. Resident medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. LPA Wesley observed one fire extinguisher in the kitchen/dining room area. The water temperature was tested and measuring 119 degrees F.

Administrator certificate for Sheila Ann Fabian #6002001735 expires 04/20/25. There were no citations issued. Exit interview conducted.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Nicol Wesley
LICENSING EVALUATOR SIGNATURE: DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2024
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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