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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603387
Report Date: 02/27/2023
Date Signed: 02/27/2023 09:45:35 AM

Document Has Been Signed on 02/27/2023 09:45 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:JMJ CAREFACILITY NUMBER:
198603387
ADMINISTRATOR:KIM, MOO JUNGFACILITY TYPE:
735
ADDRESS:1346 BALLISTA AVETELEPHONE:
(805) 259-6715
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 4CENSUS: 0DATE:
02/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jung Chun (Licensee)TIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Kruz Long conducted a site visit for the annual inspection. Upon arriving at the facility LPA met with Jung Chun (Licensee) and explained the purpose of the visit. The facility is licensed to serve: AGE RANGE 18 THROUGH 59. 4 AMBULATORY, OF WHICH 2 MAY BE NON-AMBULATORY. ROOMS 2 AND 3 APPROVED FOR NON-AMBULATORY.

The facility is located in a residential area. A tour of the single-story facility includes: Living room, dining area, kitchen, 4 bedrooms, 2 bathroom and a detached garage.

During today’s visit, LPA observed the following: There are currently zero clients in the facility. All outdoor and indoor passageways are free of obstruction. There are no pools or large bodies of water on the premises. There are no firearms on the premises and other dangerous weapons such as knives are locked. Disinfectants, cleaning solutions, poisons are locked. A comfortable temperature is maintained. Lamps or lights in all rooms to ensure the comfort and safety were observed. Hot water temperature measured at 117.5 degrees F in the bathroom. All toilets, hand washing and bathing facilities is safe, sanitary and in operating condition. Freezers and refrigerators are clean, and maintain temperatures. Smoke detector/carbon monoxide detector is operable. Fire extinguisher is fully charged.

No deficiencies were observed during today's visit.

An exit interview was conducted and a copy of this report was provided to Jung Chun.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2023
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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