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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602544
Report Date: 10/12/2023
Date Signed: 10/12/2023 04:05:58 PM

Document Has Been Signed on 10/12/2023 04:05 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:PEOPLE'S CARE FERREROFACILITY NUMBER:
198602544
ADMINISTRATOR:ANGELA WILLIAMSFACILITY TYPE:
735
ADDRESS:431 FERRERO LNTELEPHONE:
(323) 330-7545
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 4CENSUS: 3DATE:
10/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Angela Williams - AdministratorTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Tena Herrera conducted an Unannounced Case Management Visit to the facility. LPA met with Angela Williams - Administrator and explained the purpose for the visit. The purpose of today's visit is to follow up on the immediate $500 Civil Penalty (LIC421IM) issued during the 10/5/2023 complaint visit.

During today's visit LPA obtained the required signatures on the form and provided the facility with a copy of the LIC421IM along with the appeal rights.

No deficiencies observed during today's visit.

Exit interview held and a copy of this report was provided to Angela Williams.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
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)
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