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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603349
Report Date: 09/22/2023
Date Signed: 09/22/2023 12:45:50 PM

Document Has Been Signed on 09/22/2023 12:45 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:EDWARD'S COVEFACILITY NUMBER:
198603349
ADMINISTRATOR:CRUZ, EDWARD E.FACILITY TYPE:
735
ADDRESS:11954 166TH STREETTELEPHONE:
(714) 659-9152
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY: 3CENSUS: 0DATE:
09/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH: Occupant Donald CutliffTIME COMPLETED:
01:15 PM
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On 9/22/2023 at 11:30 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced annual inspection visit to Edwards Cove. LPA was greeted by an occupant (Donald Cutliff), who stated the facility has not had clients since licensure. LPA contacted licensee and left a message. The occupant of the home stated the licensee is out of town and will be back in the next two weeks. Mr. Cutliff further stated the licensee still plan on operating the facility.

LPA toured the facility with Mr. Cutliff and took photos. The home is a single store home in a residential community and contains 2 bedrooms, 1 bedroom/office, sitting area, Living room, dining room, 2 bathrooms and a storage area/hallway. There is a separate back house that the Occupant (Donald Cutliff) resides. The back house contains 1 bedroom, 1 storage room and 1 bathroom.

Due to time constraints the annual will require a continued inspection. Exit interview conducted with (Occupant) Donald Cutiliff and a copy of the report was provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2023
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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