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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603226
Report Date: 10/02/2023
Date Signed: 10/02/2023 10:23:31 AM

Document Has Been Signed on 10/02/2023 10:23 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:INSIGHT FOR LIFE @3RD AVEFACILITY NUMBER:
198603226
ADMINISTRATOR:ESCORCIA, ROGERFACILITY TYPE:
737
ADDRESS:549 S. 3RD AVETELEPHONE:
(626) 945-2709
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: 2CENSUS: 2DATE:
10/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Escorcia, RogerTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced case management visit to this facility. The purpose of this visit is to conduct a physical plant inspection of the facility. During this visit LPA conducted a tour of all areas including clients bedrooms with the assistance of the Administrator. While conducting a tour LPA observed the facility to be clean and in a good repair. Outside of physical plant was also clean and in a good repair. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded outside dining area and seating/ resting area for the clients located in the back patio.
The facility is a single-story home with 3 client’s bedrooms with 1 bed in each room and all required furniture, 2 bathrooms, living room, dining room and living area, kitchen, administrator office, office area for staff, laundry closet, attached garage. Administrator said that one of bedroom previously used as a activity room. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed.


An exit interview was conducted and copy of this report was given.




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SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2023
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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