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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602099
Report Date: 09/16/2022
Date Signed: 09/16/2022 11:26:29 AM


Document Has Been Signed on 09/16/2022 11:26 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 76DATE:
09/16/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:58 AM
MET WITH:Eleanor "Ellen" Barrientos TIME COMPLETED:
11:30 AM
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On 09/16/2022, Licensing Program Analyst (LPA) Troy Agard conducted an unannounced health check visit. Upon arrival at the facility, LPA Agard conducted a risk assessment. Based on the assessment, the facility is clear of Covid-19 infection.

LPA met with Administrator, Eleanor "Ellen" Barrientos. LPA was following up on 3 residents that were temporarily relocated. LPA conducted interviews with the Administrator, R1, and R2. R3 was unavailable at the time of visit. Both residents were observed to be in good health and spirit.

An exit interview was conducted, and a copy of this report was provided to Administrator.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2022
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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