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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603336
Report Date: 05/24/2023
Date Signed: 05/24/2023 05:44:43 PM

Document Has Been Signed on 05/24/2023 05:44 PM - 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:BAILEY'S PLACE ADULT COMMUNITY CENTER LLCFACILITY NUMBER:
198603336
ADMINISTRATOR:BROOKS, BRANDIFACILITY TYPE:
775
ADDRESS:1216-1218 E. ROSECRANS AVETELEPHONE:
(214) 240-4247
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 32CENSUS: 22DATE:
05/24/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
10:37 AM
MET WITH:Yolanda Williams TIME COMPLETED:
12:41 PM
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On 05/24/23 Licensing Program Analyst (LPA) Ernand Dabuet initiated a Collateral visit at this day program. LPA met with Program Director Yolanda Williams. LPA explained the purpose of this visit is to gather information regarding a current complaint about Living Well 2 Complaint number 11-AS-20230515130137.

The investigation visit consisted of an interview with client #1 (C1) and Program Director witness #1 (W1). (C1) who currently resides as a consumer at Living Well 2 #198602077. Details of the interviews are documented on LIC 812 crossed reference with Living Well 2.

An exit interview was conducted with Yolanda Wiliams, and copy of the report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2023
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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