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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600864
Report Date: 11/09/2023
Date Signed: 11/09/2023 05:34:57 PM

Document Has Been Signed on 11/09/2023 05:34 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:NORWALK HOMEFACILITY NUMBER:
198600864
ADMINISTRATOR:MELANIE ESTEPAFACILITY TYPE:
735
ADDRESS:14813 CAMEO AVENUETELEPHONE:
(562) 404-2849
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 5CENSUS: 4DATE:
11/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH:Melanie EstepaTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced Required 1 year inspection at the facility and met with Administrator Melanie Estepa and explained the purpose for todays visit. The facility phone number is 562 404 2849.

The facility consist of 5 bedrooms, 1 staff bedroom, 3 bathrooms, living room, dining room, kitchen, garage, backyard, laundry area outside, area for shade.

The facility had all postings at the front entrance, bathrooms, and throughout the facility. A Pre screening area with PPE supplies was observed upon entry into the facility.

LPA 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 observed one fire extinguisher in the kitchen. The water temperature was tested and measured 111.6-112.2 degrees F. LPA Wesley discussed the infection control plan with the Administrator at the time of visit.
The last fire drill was conducted on 11/02/2023.

Administrators certificate for Melanie Estepa #6030475735, expires on 04/03/2024.

There were no deficiencies cited.

Exit interview conducted.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Nicol Wesley
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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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