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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601369
Report Date: 10/01/2024
Date Signed: 10/01/2024 04:26:48 PM

Document Has Been Signed on 10/01/2024 04:26 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:MORALES FAMILY HOMEFACILITY NUMBER:
198601369
ADMINISTRATOR/
DIRECTOR:		ERNEST LUNAFACILITY TYPE:
735
ADDRESS:1821 PIERCE PLACETELEPHONE:
(626) 573-9126
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91755
CAPACITY: 4CENSUS: 4DATE:
10/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:51 PM
MET WITH:Ernest Luna, Administrator TIME VISIT/
INSPECTION COMPLETED:
04:42 PM
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Licensing Program Analyst (LPA) Alberto Lopez made unannounced visit to follow up on Regional Center inspection dated 04/17/2024. LPA met with Administrator Ernest Luna and discussed the purpose of the visit.

LPA reviewed and obtained copies of staff and resident rosters.

LPA inspected the following deficiencies noted by Regional Center.

PHYSICAL ENVIRONMENT:

1) Old Water damage in the ceiling in the activity room.
Water damage has been removed and painted.
2) Declutter some items in the living room.
Living room is decluttered.
3) Ensure all individual binders need to be locked in cabinet or other area. .
Binders are stored in area inaccessible to clients.

STAFFING:
1) Staff have knowledge of reporting requirements.
LPA reviewed and obtained proof that staff have training in reporting requirements.

LPA toured facility and did not observed any deficiencies during visit.

Exit interviewed conducted and copy of report and appeal rights provided to Administrator.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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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