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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601959
Report Date: 03/27/2024
Date Signed: 03/27/2024 12:26:52 PM


Document Has Been Signed on 03/27/2024 12:26 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:MOM & DAD'S HOUSEFACILITY NUMBER:
198601959
ADMINISTRATOR:IVONNE A. MEADERFACILITY TYPE:
740
ADDRESS:4340 CONQUISTA AVE.TELEPHONE:
(562) 627-0390
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY:6CENSUS: 6DATE:
03/27/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Matthew Meader and Ivonne Meader - LicenseesTIME COMPLETED:
12:25 PM
NARRATIVE
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On 03/27/24, an informal meeting was held at the Monterey Park Adult and Senior Care Regional Office. The purpose of this office meeting was to discuss deficiencies issued at the facility – Mom & Dad’s House - 198601959.

Present in today’s meeting: Licensing Program Manager – Adeline Ho, Licensing Program Manager – Lisa Hicks, Licensing Program Analyst – Luis Mora, Licensing Program Analyst – Angelica Rea, Licensee – Matthew Meader and Licensee – Ivonne Meader.

During the meeting, the following were addressed:

  • Complaint investigation findings for complaint control number 28-AS-20210415130140 and 28-AS-20210621085853.
  • Pre-admission fee of $2500 was added to the admission agreement without notifying CCLD.
  • Created a waiver of liability and hold harmless agreement for a resident without notifying CCLD.
  • Importance of following the plan of operation and notifying CCLD of any changes.
  • Importance of seeking CCLD's advice prior to implementation.

The following Title 22 topics were discussed and copy of the section were given during the office meeting:

  • Plan of Operation 87208.
  • CCLD mission statement.

An exit interview was conducted and a copy of this licensing report was provided.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis MoraTELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
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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