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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602099
Report Date: 08/16/2023
Date Signed: 08/16/2023 03:16:30 PM


Document Has Been Signed on 08/16/2023 03:16 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:CORAL OAKS CARE LIVINGFACILITY NUMBER:
198602099
ADMINISTRATOR:ELEANOR BARRIENTOSFACILITY TYPE:
740
ADDRESS:4271 CARLIN AVETELEPHONE:
(310) 763-4881
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:84CENSUS: 74DATE:
08/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Administrator - Eleanor BarrientosTIME COMPLETED:
03:30 PM
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On 08/16/2023 Licensing Program Manager (LPM) Ulysses Coronel & Licensing Program Analyst (LPA) Socorro Leandro conducted a Case Management - Other visit and met with Administrator Eleanor Barrientos and the purpose of todays visit was explained.

During todays visit LPM and LPA conducted a tour of the facility which included bedrooms number 34, 35 and 36. LPM, LPA and Administrator inspected residents beddings and did not observe the presence of bed bugs.

LPM & LPA also reviewed 8 random residents Personal and Incidental (P&I) records with Michalene Johnson.

No violations of Title 22 Regulations were observed and cited during todays visit.

An exit interview was conducted and a copy of this report was provided to Administrator Eleanor Barrientos.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2023
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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