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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603118
Report Date: 11/13/2020
Date Signed: 05/19/2021 03:30:56 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: 79DATE:
11/13/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:42 PM
MET WITH:Matthew RobisonTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Don Senaha initiated an unannounced Case Management - Incident Report. Due to the situation surrounding the Corona virus Disease 2019 (COVID-19), and to implement mitigation measures, todays visit was conducted telephonically with Matthew Robison.

Due to internet connection issues, LPA was unable to do a tour of area under construction; however, videos were sent from Matthew Robison showing the area under construction. Videos included, the back of the building which has the entrance to the laundry room. The area under construction on the first floor including the common area is safely masked off to keep all residents from entering. Drywall is being replaced in laundry room, break room and three resident rooms. These residents have been safely relocated to the 2nd floor.

A telephonic exit interview was conducted with Matthew Robison and a hard copy this report was provided via email for signature.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don SenahaTELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2020
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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