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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601067
Report Date: 03/01/2024
Date Signed: 03/01/2024 04:34:56 PM

Document Has Been Signed on 03/01/2024 04:34 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:SYLVANWOOD RESIDENTIAL CARE HOMEFACILITY NUMBER:
198601067
ADMINISTRATOR:FABIAN, ALVIN S.FACILITY TYPE:
735
ADDRESS:16428 SYLVANWOOD AVENUETELEPHONE:
(562) 860-6041
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 4CENSUS: 4DATE:
03/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Lerma CacayurinTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced Required 1 year inspection at the facility and met with Lerma Cacayurin explained the purpose for todays visit. The facility phone number is 562 860 6041.

The facility consist of four resident bedrooms, one staff room, two bathrooms, a living room, dining room, kitchen, laundry room, office/work area, covered patio located in the back yard, and a garage(storage).

The facility had all postings at the front entrance, bathrooms, and throughout the facility.

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 observed one fire extinguisher in the kitchen/living room area. The water temperature was tested and measured between 118.0-119.9 degrees F.

There were no deficiencies cited.

Exit interview conducted.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Nicol Wesley
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2024
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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