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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602177
Report Date: 05/19/2022
Date Signed: 05/19/2022 02:58:05 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/18/2022 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220518135158
FACILITY NAME:LIVE WELL RESIDENTIAL CAREFACILITY NUMBER:
198602177
ADMINISTRATOR:ANGULUAN, JOVANNEFACILITY TYPE:
740
ADDRESS:211 E CLARION DRIVETELEPHONE:
(310) 435-8608
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY:6CENSUS: 6DATE:
05/19/2022
UNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:JOVANNE ANGULUANTIME COMPLETED:
11:14 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
PERSONAL RIGHTS
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 05/19/22 Licensing Program Analyst (LPA) Ernand Dabuet conducted a complaint visit to investigate the allegation indicated above. LPA met with Jovanne Anguluan administrator and explained the purpose of the visit.

Based on record review of resident and staff roster, it was determined that (R1) does not reside at this facility. R1 has never been a resident at this facility and has no association with any residents or staff. The individuals named on the SOC 341 are not associated with this facility in any manner.

This agency has investigated the complaint alleging "Personal Rights". We have found that the complaint is unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

Exit interview held, and a copy of this report was provided to Jovanne Anguluan.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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