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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601766
Report Date: 01/29/2024
Date Signed: 01/29/2024 08:32:35 PM


Document Has Been Signed on 01/29/2024 08:32 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245



FACILITY NAME:OLIVIA ISABEL MANORFACILITY NUMBER:
198601766
ADMINISTRATOR:KUNZ, ANAFACILITY TYPE:
735
ADDRESS:21515 S. FIGUEROA STREETTELEPHONE:
(310) 328-5116
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY:110CENSUS: 90DATE:
01/29/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:24 PM
MET WITH:Ana Kunz & Lynn Tran TIME COMPLETED:
02:30 PM
NARRATIVE
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On 01/29/24 at 1:30 pm, an office meeting was conducted with Administrator Ana Kunz and Licensee Lynn Tran. In attendance are Regional Manager (RM) Benita Yates, Licensing Program Manager (LPM) Janae Hammond, and Licensing Program Analyst (LPA) Ernand Dabuet. The purpose of this meeting was to discuss the procedures for Change of Ownership.

During the office meeting (RM) Yates conducted a brief overview of the terms and conditions for the Change of Ownership for Olivia Isabel Manor. Discussions of limitations and conditions for a Change of Ownership,

The Licensee and the Administrator were provided during meeting information for Centralized Application Bureau Phone: (833) 827-6084 Fax: (916) 651-7916 email: CCLASCPCAB@dss.ca.gov. A letter of intent must be sent to El Segundo Adult and Senior Care Licensing within 60 days of receiving a bona fide offer for change of ownership.

An exit interview with licensee Lynn Tran and a copy of the report is provided.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:
DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2024
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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