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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
198601422
Report Date:
07/15/2022
Date Signed:
07/15/2022 02:12:39 PM
Document Has Been Signed on
07/15/2022 02:12 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 DR #100
MONTEREY PARK
,
CA
91754
FACILITY NAME:
CALIFORNIA EMPLOYMENT SUPPORT SERVICES, INC.
FACILITY NUMBER:
198601422
ADMINISTRATOR:
FRANK AIFUWA
FACILITY TYPE:
775
ADDRESS:
11144 WASHINGTON BLVD
TELEPHONE:
(310) 559-2200
CITY:
CULVER CITY
STATE:
CA
ZIP CODE:
90232
CAPACITY:
30
CENSUS:
DATE:
07/15/2022
TYPE OF VISIT:
Case Management - Deficiencies
UNANNOUNCED
TIME BEGAN:
09:35 AM
MET WITH:
Frankl Aifuwa
TIME COMPLETED:
01:20 PM
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On 07/15/22 LPA Johnson observed the bathroom in disrepair.
A signed copy of this report was given to Administrator Aifuwa.
SUPERVISORS NAME
:
Eva M Alvarez
LICENSING EVALUATOR NAME
:
Gail Johnson
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/15/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/15/2022
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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