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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602190
Report Date: 09/13/2024
Date Signed: 09/13/2024 04:56:03 PM


Document Has Been Signed on 09/13/2024 04:56 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245



FACILITY NAME:CASA DEL SOL RESIDENCEFACILITY NUMBER:
198602190
ADMINISTRATOR:JACOBS, DOV EFACILITY TYPE:
740
ADDRESS:11606 11602 W WASHINGTON BLVDTELEPHONE:
(323) 678-4426
CITY:CULVER CITYSTATE: CAZIP CODE:
90066
CAPACITY:12CENSUS: 2DATE:
09/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:27 PM
MET WITH:Valerie Hanson - Case ManagerTIME COMPLETED:
04:57 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) Troy Watson conducted an unannounced visit to Dewey Home Inc. on 09/13/2024 at 08:50 AM. The LPA met with the Administrator Ivan Bravo and the purpose of the visit was explained. The facility is licensed to serve 6 non-ambulatory residents and currently has a census of (0). Hospice waiver for 3 residents. The facility does not handle any of the resident’s money. Because of time constraints this annual visit will have to be continued at a later time. .

An exit interview was conducted, and a copy of this report was provided to the Administrator Ivan Bravo.

SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (424) 544-1088
LICENSING EVALUATOR NAME: Troy WatsonTELEPHONE: (424) 544-1069
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024
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