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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602364
Report Date: 10/12/2023
Date Signed: 10/17/2023 09:23:34 AM

Document Has Been Signed on 10/17/2023 09:23 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CN HOME 2FACILITY NUMBER:
198602364
ADMINISTRATOR:MATHARU, ANITAFACILITY TYPE:
735
ADDRESS:14516 PIONEER BLVDTELEPHONE:
(310) 612-0978
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 4CENSUS: 4DATE:
10/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Vany Long RasileTIME COMPLETED:
05:15 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) Nicol Wesley conducted an unannounced Required 1 year inspection at the facility and met with Margarita Aquino and later Administrator Vany Rasile arrived and the purpose of the visit was explained. The facility phone number is 562 929 2733.

The facility consist of 4 bedrooms, 2 bathrooms, kitchen, living room, dining room, office room, hallway with laundry machines, and the backyard with shaded area.

The facility had all postings at the front entrance, bathrooms, and throughout the facility. A Pre screening area with PPE supplies was observed upon entry into the facility.

LPA conducted a complete tour of the facility, and observe the supply of food. Resident medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. LPA observed one fire extinguisher in the kitchen. The water temperature was tested and measured 113.3 degrees F. LPA Wesley received a copy of the facility infection control plan at the time of visit.

Administrators certificate for Vany Long Rasile #6067481735, expires on 08/28/25

There were no deficiencies cited.

Exit interview conducted.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Nicol Wesley
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023
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