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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602099
Report Date: 08/15/2022
Date Signed: 08/15/2022 05:56:30 PM


Document Has Been Signed on 08/15/2022 05:56 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, 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: 72DATE:
08/15/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Eleanor BarrientosTIME COMPLETED:
12:40 PM
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On 08/15/2022 Licensing Program Analyst (LPA) Martessa and Regional Manager (RO) Angela Kendrick to conducted a Case Management - Health and Safety Check to the above facility and met with Eleanor Barrientos, the Administrator and explained the purpose of todays visit. LPA conducted a risk assessment before entering in the facility and observed Covid-19 Protocol.

The purpose of today’s visits was to conduct a health and safety check for residents #R1, R#2 and R3. Residents recently moved from OathPark Facility.

During today visit LPA and RO conducted a tour of the facility and interviewed R#1-R#2. LPA and RO observed residents and they were fine. R#3 was not in the facility and was unable to interview. LPA reviewed the following records: R#1-#2's Admissions Agreements Medication Logs, medications, emergency contacts and physicians’ reports. LPA also reviewed R#3's Admissions Agreement and emergency contact.

No deficiencies were cited. A copy of this report was provided to Eleanor Barrientos.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2022
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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