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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602623
Report Date: 07/22/2022
Date Signed: 07/25/2022 12:58:55 PM


Document Has Been Signed on 07/25/2022 12:58 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:VISTA DEL MAR VILLASFACILITY NUMBER:
198602623
ADMINISTRATOR:CHEN, DERICKFACILITY TYPE:
740
ADDRESS:3049 EAST DEL MAR BLVDTELEPHONE:
(626) 215-1045
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY:6CENSUS: 4DATE:
07/22/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Christina ChenTIME COMPLETED:
11:15 AM
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Licensing Program Analyst(s)(LPA) Mary Flores and Licensing Program Manager (LPM) Fernando Fierros conducted a office virtual Microsoft Teams meeting with Licensees Christina Chen and Derrick Chen to discuss a possible closure of the facility.

The following was discussed during this meeting:

Process of closure or change of ownership.
60 day notices for residents.
Responsibility of licensee on licensed facility through closure process.
Licensee must maintain control of property until closure date.
Consult with attorney for legal matters.
Information to review by licensee SB741 AB Leno, AB949, eviction notice.
Documents to be prepared by licensee for proper placement: Resident's Service Plan, referrals in 60 miles radius, and evaluation of placement.
Documents to be submitted to the department: Physician report, Hospice plan, service plan, referrals in 60 miles radius an 60 day notice for review.

If the Licensee should decide to proceed with a closure or change of ownership, the licensee shall submit a signed and dated letter to the department and include the purpose for closing and effective
date for closure, along with relocation packets.

Licensee to submit verification of control of property by Monday 07/25/22,.

Exit interview was conducted with Christina Chen and Derrick Chen and a copy of this report was email for signature.
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022
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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