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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603312
Report Date: 01/05/2024
Date Signed: 01/05/2024 09:34:45 AM


Document Has Been Signed on 01/05/2024 09:34 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:JAGS RESIDENTIAL CARE FACILITY FOR THE ELDERLYFACILITY NUMBER:
198603312
ADMINISTRATOR:ENRIQUEZ, JALEELFACILITY TYPE:
740
ADDRESS:1387 EAST 110TH STREETTELEPHONE:
(323) 244-1702
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY:6CENSUS: 0DATE:
01/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Jaleel EnriquezTIME COMPLETED:
09:50 AM
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On 01/05/2024, LPA Antonine Richard conducted a Case Management other visit to the facility above. LPA met with Licensee Jaleel Enriquez. The facility is licensed for six (6) residents for elderly currently, there are zero (0) residents in placement and zero (0) staff.

LPA Richard and Jaleel toured the inside and outside grounds of the facility. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) residents bedrooms, two (2) bathrooms, one (1) living area, one (1) dining area and kitchen. The garage is detached from the house in the backyard.

The Licensee, Jaleel stated the facility had no clients since it opened. Licensee stated she was in the process of closing the facility due to hardship. The Licensee stated she did talk to someone at Licensing about closing the facility months ago. LPA did not observe any Residents and any staff present during the visit. LPA Richard received a copy of the License from Licensee.

An exit interview conducted and a copy of the report was provided to licensee Jaleel Enriquez.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine RichardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2024
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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