<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603203
Report Date: 02/09/2024
Date Signed: 02/09/2024 11:01:09 AM

Document Has Been Signed on 02/09/2024 11:01 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:CONGREGATE CONNECT - ARBUTUSFACILITY NUMBER:
198603203
ADMINISTRATOR:HERBERT LEEFACILITY TYPE:
735
ADDRESS:714 W ARBUTUS STREETTELEPHONE:
(213) 792-4414
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 4CENSUS: 4DATE:
02/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Jennifer NormanTIME COMPLETED:
11:20 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 02/9/2024, Licensing Program Analyst (LPA) Lizeth Villegas conducted a Case Management visit to the facility above. For the purpose of following up on a confirmation of removal notification. LPA met with Administrator Jennifer Norman and explained the reason for the visit.

A notification letter was generated to notify the licensee of an individual (AH Sir) confirmation of removal. LPA spoke with Administrator Jennifer Norman who explained that (AH Sir) was an employee they were trying to hire. The individual (AH Sir) never worked at the facility.

During this visit, LPA obtained a copy of the Personnel Report (LIC 500) from the Administrator, which confirm that (AH Sir) is not working at the facility. The Department received information an individual (AH Sir) should not be on site, and this has been verified during today’s visit.

No citations issued during today's visit.

Report reviewed and signed, exit interview conducted, and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1