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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602851
Report Date: 07/25/2023
Date Signed: 07/25/2023 02:59:05 PM

Document Has Been Signed on 07/25/2023 02:59 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:LIVING WELL #3FACILITY NUMBER:
198602851
ADMINISTRATOR:JUSTICE, RICHARDFACILITY TYPE:
735
ADDRESS:12825 BELHAVEN AVETELEPHONE:
(310) 933-8837
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY: 4CENSUS: 0DATE:
07/25/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Karon HowellTIME COMPLETED:
02:30 PM
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On 07/25/23, an office meeting was held in the El Segundo Adult & Senior Care Office. Present during the meeting was Janae Hammond Licensing Program Manager (LPM), Stephanie Cifuentes Licensing Program Manager (LPM), Villegas Licensing Program Analyst (LPA), Ernand Dabuet (LPA),
Karon Howell (Administrator), Stacy O. Johnigram (Consultant), and Reginal King (Consultant). The purpose of the meeting was to discuss a visit conducted on 07/5/23 by LPA Villegas.
On 07/05/23, LPA Villegas conducted an Annuals Inspection to Living Well #3. Upon arrival to the facility LPA did not observe any staff present while a client was in care. Based on the LPAs observation it was determined there was a violation of Title 22 Regulations due to absence of supervision.
During today’s meeting, LPM Hammond discussed concerns the departments has due to Absence of Supervision at the facility. LPM discussed the Licensees concerns with the clients being removed from the home by South Central Los Angeles Regional Center (SCLARC). LPM Hammond explained SCLARC and CCLD work collaboratively and CCLD is mandated to cross report to SCLARC. LPM explained SCLARC is the sole decision maker for the placement/removal of clients based on their own information and regulations. LPM informed Licensee she can contact SCLARC directly regarding concerns with the removal of the clients.

During today’s meeting the following was completed:
• LPA Villegas amended the licensing report dated 07/5/23 to for Living Well #3 to correct the citation issued and issue the $500 immediate civil penalty for Absence of Supervision. LPA Villegas will provide appeal rights for amended report.
• LPA Dabuet delivered investigation finding for Living Well # 2 to Administrator Karon Howell.
The following will be completed following office meeting:
Regional office will reach out to SCLARC
The licensee indicated that an appeal will be submitted to the department via email.

Exit interview conducted, and a copy of this report was provided to Administrator Karon Howell.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2023
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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