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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602885
Report Date: 08/31/2024
Date Signed: 08/31/2024 01:24:56 PM


Document Has Been Signed on 08/31/2024 01:24 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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:BRADDOCK HOMEFACILITY NUMBER:
198602885
ADMINISTRATOR:DRUMMOND, MARIAFACILITY TYPE:
740
ADDRESS:12136 BRADDOCK DRIVETELEPHONE:
(310) 902-4893
CITY:CULVER CITYSTATE: CAZIP CODE:
90230
CAPACITY:4CENSUS: DATE:
08/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:House Manager - Brianna SimpsonTIME COMPLETED:
01:40 PM
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On 08/31/2024 at around 12:20 AM, Licensing Program Analyst (LPA) Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with staff and explained the purpose of the visit. Due to unforeseen circumstances LPA was unable to complete the Annual Inspection.

No deficiencies are being cited today.

An exit interview was conducted, and a copy of this report was left with the House Manager.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2024
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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