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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602997
Report Date: 03/14/2025
Date Signed: 03/20/2025 08:08:13 PM

Document Has Been Signed on 03/20/2025 08:08 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:FAGAN HOME CAREFACILITY NUMBER:
198602997
ADMINISTRATOR/
DIRECTOR:
ANSELMO, YETZIRAFACILITY TYPE:
740
ADDRESS:19742 FAGAN WAYTELEPHONE:
(562) 215-3265
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 5TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
03/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Yetzira Anselmo,TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced Required 1 year inspection at the facility and met with Administrator Yetzira Anselmo and explained the purpose for todays visit. The facility phone number is 562 402 0326.

The facility consist of four resident bedrooms, three bathrooms(1 in bedroom #1), 2 staff rooms, living room, dining room. kitchen and covered patio located in the back yard, and an attached garage(storage).

During the visit the Inspection tool was used and the following areas were observed/inspected: The facility had all postings at the front entrance, bathrooms, and throughout the facility. Hand sanitizing gel and masks was at the Pre screening area upon entry into the facility.

LPA Wesley conducted a complete tour of the facility, and observe the supply of food. Resident medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. The last fire drill was on 02/28/25.


LPA Wesley observed one fire extinguisher in the kitchen. The water temperature was tested and measured 117 degress F. The Administrators certificate for Yetzira Anselmo #6044039740, expires 04/18/2025.
There were no deficiencies cited.

Exit interview conducted.
Lisa HicksTELEPHONE: (323) 981-3972
Nicol WesleyTELEPHONE: (323) 981-3975
DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2025
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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