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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602031
Report Date: 02/08/2024
Date Signed: 02/08/2024 02:13:28 PM

Document Has Been Signed on 02/08/2024 02:13 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:TOTAL LIFE CARE, INC - EVOLVE SERVICESFACILITY NUMBER:
198602031
ADMINISTRATOR:MONTESINOS, JESSICAFACILITY TYPE:
775
ADDRESS:545 EREMLAND DRIVETELEPHONE:
(626) 257-3235
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY: 60CENSUS: 27DATE:
02/08/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:30 AM
MET WITH:Nilesh MakwanaTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Wong conducted a case management visit at the facility to check on the health and safety of the clients in care. LPA met with the Assistant Director Nilesh Makwana (Neil) and allowed the entry of the visit and assisted with the visit.

During the visit, LPA conducted a health and safety check of the clients which include tour the facility and LPA did not observe any health and safety issues of the clients based on the Title 22 regulation.

No deficiencies observed during today's visit. Exit interview held and a copy of the report was provided to the Assistant Director.


SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024
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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