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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602620
Report Date: 09/10/2024
Date Signed: 09/10/2024 10:14:02 AM

Document Has Been Signed on 09/10/2024 10:14 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:LONG BEACH RESIDENTIALFACILITY NUMBER:
198602620
ADMINISTRATOR/
DIRECTOR:		CRYSTAL BARRIENTOSFACILITY TYPE:
735
ADDRESS:4201 EAST 10TH STREETTELEPHONE:
(562) 433-2455
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY: 49CENSUS: 49DATE:
09/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:01 AM
MET WITH:Anthony Griffin & Marinel LunaTIME VISIT/
INSPECTION COMPLETED:
10:29 AM
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On 09/10/24, Licensing Program Analysts (LPA) Ernand Dabuet conducted an unannounced Case Management visit to Long Beach Residential. The purpose of today’s visit is to serve an ORDER TO LICENSEE/FACILITY OF IMMEDIATE EXCLUSION FROM FACILITY for staff #1. LPA met with licensee Myla Bonzon by telephone and staff Marinel Luna in person. LPA explained the purpose of today’s visit.

An investigation conducted by the California Department of Social Services determined that staff #1 violated California Code of Regulations Title 22 for the client's personal rights. Government Code 11522 was also issued, informing the licensee that an excluded person may petition for reinstatement to the Department one year after the effective date of the exclusion order. LPA delivered copies of the immediate exclusion letters for the following facility to the licensee, Myla Bonzon.

Staff #1 (S1) was present at the facility at the time of the visit and was provided with the Immediate Exclusion Order letter and Government Code 11522. The licensee, Myla Bonzon was read the Immediate Exclusion from Facility Order by telephone and stated she understands the immediate exclusion order and that she understands the mentioned staff is not allowed to be physically present in the facility.

An exit interview was conducted with Myla Bonzon and Marinel Luna and copies of Order to Licensee/Facility of Immediate Exclusion from Facility and Government Code 11522 were provided. The report was signed by Assistant Administrator Anthony Griffin and Marinel Luna.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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