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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602954
Report Date: 11/02/2023
Date Signed: 11/02/2023 11:17:58 AM

Document Has Been Signed on 11/02/2023 11:17 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:JENESIS HOMES 2FACILITY NUMBER:
198602954
ADMINISTRATOR:MOCLING, JOANN AFACILITY TYPE:
735
ADDRESS:15019 ROSALITA DRIVETELEPHONE:
(714) 684-4972
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY: 4CENSUS: 4DATE:
11/02/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Staff Velinda TuzonTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Jose Villalobos conducted subsequent unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Staff Velinda Tuzon. The following (2) of (12) CARE tool domains were completed during the inspection:

Staffing
  • Sufficient staff observed to meet clients needs
  • Facility provided care and supervision for a total of (4) Clients.

Personnel Records-Training:
  • Administrator on record is current. Administrator Certification is active
  • Staff have criminal background clearance and training.
  • Five (5) staff files were reviewed. Proof of staff training, health clearance, and 1st Aid/CPR and CPI training was observed.



All (12) domains have been completed as of todays visit. Per California Code of Regulations, Title 22, No deficiencies are being cited. Exit Interview Conducted and a copy of this report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2023
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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