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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601490
Report Date: 03/14/2023
Date Signed: 03/14/2023 10:08:55 AM

Document Has Been Signed on 03/14/2023 10:08 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:EPIC RESIDENTIAL HOMES INC #3FACILITY NUMBER:
198601490
ADMINISTRATOR:MORRIS, MARCUSFACILITY TYPE:
735
ADDRESS:6054 6TH AVETELEPHONE:
(323) 320-6267
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY: 4CENSUS: 4DATE:
03/14/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:MORRIS, MARCUSTIME COMPLETED:
10:08 AM
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A Licensing Program Analyst (LPA), David España and LPM Ulysses Coronel, conducted an unannounced visit at Epic Residential Homes Inc #3. The objective of today's unannounced, mandatory comprehensive annual inspection was to focus on using the CARE Inspection Tools. Additionally, LPM Coronel and LPA conducted staff interviews and client record review.

LPA observed no deficiencies during the inspection visit:

An exit interview conducted with Administrator, Mr. Marcus Morris and a copy of report and appeal rights provided.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2023
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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