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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603118
Report Date: 07/30/2020
Date Signed: 08/05/2020 04:48:55 PM

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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:CLEARWATER AT SOUTH BAYFACILITY NUMBER:
198603118
ADMINISTRATOR:ARLENE CRAWFORDFACILITY TYPE:
740
ADDRESS:3210 & 3212 W SEPULVEDA BLVDTELEPHONE:
(424) 488-6340
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY:137CENSUS: 88DATE:
07/30/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:56 AM
MET WITH:Michael KriegerTIME COMPLETED:
02:27 PM
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Licensing Program Analyst (LPA) Ulysses Coronel initiated an unannounced Case Management - Other to provideTechincal Assistance to the above said facility. Due to the situation surrounding the Corona virus Disease 2019 (COVID-19), and to implement mitigation measures, todays visit was conducted telephonically with Vice President of Operations Michael Krieger.

A tour of the facility's common area was conducted, LPA was given a tour of buildings 3210 and 3212 by Maintenance Director Saul Galvan via a Facetime video call. The tour consisted of reviews of both buildings common areas which included both buildings, dining rooms, activity rooms, public restrooms, elevators and bedroom hallways and courtyards. LPA also reviewed the facility's social distancing practices and protective facial covering practices.

A telephonic exit interview was conducted with Michael Krieger and a hard copy was provided via email for signature.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2020
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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