<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603474
Report Date: 12/05/2024
Date Signed: 12/05/2024 10:18:41 AM

Document Has Been Signed on 12/05/2024 10:18 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:HELIOFACILITY NUMBER:
198603474
ADMINISTRATOR/
DIRECTOR:		MARCELO, TAJFACILITY TYPE:
735
ADDRESS:510 FOXPARK DRIVETELEPHONE:
(929) 429-0836
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 4CENSUS: 3DATE:
12/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Yanet Saldana/S-1TIME VISIT/
INSPECTION COMPLETED:
10:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Elizabeth Irra and Mayra Cota conducted a Case Management Visit today regarding a special incident which occurred on 11/30/24 involving Client #1 (C-1). LPA interviewed Yanet Saldana/S-1. LPA spoke to Taj Marcelo Rossi (Administrator) via telephone.

LPA toured the facility grounds and did not observe any health and safety concerns. Ms. Marcelo-Rossi will continue to keep LPA informed of any further developments pertaining to C-1's incident.

An exit interview was conducted and a copy of this report was given to Yanet Saldana/S-1.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1