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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602264
Report Date: 05/11/2022
Date Signed: 05/12/2022 09:38:29 AM


Document Has Been Signed on 05/12/2022 09:38 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:TERRAZA COURTFACILITY NUMBER:
198602264
ADMINISTRATOR:GREG BECKERFACILITY TYPE:
740
ADDRESS:10955 WASHINGTON BLVDTELEPHONE:
(310) 838-7800
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY:115CENSUS: 63DATE:
05/11/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Galina TovmasianTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced Case Management Visit. Upon arrival at the facility, LPA Bunker called the facility and spoke to the Receptionist Tyrenetta Gaigher via telephone to conduct a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection.

LPA Bunker was properly screened for COVID-19 symptoms and temperature was checked. LPA observed a sanitizing station at the facility receptionist area front entrance; visitors log with COVID-19 screening and temperature log, and records of daily COVID-19 screening and temperature checks of residents and staff.

LPA Bunker met with Business Office Manager Galina Tovmasian and explained the primary purpose of today's visit, was to amend the Complaint Investigation Report dated 02/04/2022, Control # 11-AS-20220127124528, that stated staff tested positive for COVID-19 to unqualified staff. LPA Bunker also, requested copies of supporting documents.

There were no deficiencies cited.

Exit interview conducted.
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2022
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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