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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601302
Report Date: 03/24/2023
Date Signed: 03/24/2023 12:35:28 PM

Document Has Been Signed on 03/24/2023 12:35 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:C-H ADULT DAY CENTER PROGRAMFACILITY NUMBER:
198601302
ADMINISTRATOR:BROWN, MARIETTAFACILITY TYPE:
775
ADDRESS:8026 E ALONDRA BLVDTELEPHONE:
(562) 630-8123
CITY:PARAMOUNTSTATE: CAZIP CODE:
90723
CAPACITY: 70CENSUS: DATE:
03/24/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
11:32 AM
MET WITH:Maricruz Salinas- Facility SupervisorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) V. Maldonado made an unannounced collateral visit at the day program for the purpose of conducting interviews with Clients# 1-2 (C1-C2) regarding a complaint investigation, related to their facility. The complaint being investigated is not related to this day program. LPA Maldonado met with Facility Supervisor Maricruz Salinas and explained the purpose for the visit.

During the visit, LPA conducted interviews with C1-C2 in a private area in the classroom they are assigned to. Upon completing the interviews, the visit was ended.

An exit interview was conducted with Facility Supervisor Maricruz Salinas and a copy of the report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Valeria Maldonado
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2023
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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