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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602925
Report Date: 08/14/2024
Date Signed: 08/14/2024 04:30:03 PM

Document Has Been Signed on 08/14/2024 04:30 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:COLE VOCATIONAL SERVICES PACIFICFACILITY NUMBER:
198602925
ADMINISTRATOR/
DIRECTOR:		DARCY FARIASFACILITY TYPE:
775
ADDRESS:2290 PACIFIC AVETELEPHONE:
(562) 349-0520
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY: 30CENSUS: 12DATE:
08/14/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:04 PM
MET WITH:Program Supervisor Brandon GarciaTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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On 08/14/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a collateral visit at the above facility to interview Client #1 for complaint #11-AS-20240807164736. LPA met with Program Supervisor Brandon Garcia and explained the purpose of the visit. The investigation consisted of the following: During today’s visit, LPA interviewed Client #1.

An exit interview was conducted and a copy of this report was provided to Program Supervisor Brandon Garcia.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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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