<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602183
Report Date: 07/30/2021
Date Signed: 07/30/2021 02:20:11 PM

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:JORDAN GUEST HOMEFACILITY NUMBER:
198602183
ADMINISTRATOR:BOHANAN, VILMA TRAZOFACILITY TYPE:
740
ADDRESS:10657 JORDAN ROADTELEPHONE:
(562) 822-4677
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY:6CENSUS: 6DATE:
07/30/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Administrators Vilma Bohanon and James Trazo TIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced Case Management Visit to do a health and safety check due to sale listing posted of the facility property address. LPA was met by Administrator Vilma Bohanon and LPA explained the reason for the visit.

Prior to visit, LPA was provided with proof of Licensee's control of property. During today's visit LPA interviewed Administrator VIlma Bohanon and James Trazo. LPA received proof that monthly payment from the lease agreement was paid for the month of July. LPA was informed that property owner intends to possibly sell the property in the future but stated the new owner would continue leasing the property to the facility.

LPA also toured the physical plant of the facility. The facility appeared to be in good repair. Required amount of food supply was observed. Water and Electricity were operational. Pool in the backyard was locked and inaccessible to residents. LPA did not observe the facility in disrepair or objects blocking the walk areas for residents.

No deficiencies observed during today's visit. Exit interview held and a copy of the report was provided to the facility.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1