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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603489
Report Date: 06/22/2023
Date Signed: 06/22/2023 06:02:52 PM

Document Has Been Signed on 06/22/2023 06:02 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ABOVE AND BEYOND ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
198603489
ADMINISTRATOR:SAUNDERS, TONYAFACILITY TYPE:
735
ADDRESS:430 S. MOUNTAINTELEPHONE:
(951) 323-3852
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 4CENSUS: 4DATE:
06/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:13 PM
MET WITH:Tonya SaundersTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Case Management Visit on 06/22/23 at 4:00pm. The purpose of the visit was to serve the ORDER TO INDIVIDUAL FOR IMMEDIATE EXCLUSION FROM FACILITY on Staff #1(S1) and Staff #2 (S2). An investigation by the California Department of Social Services was conducted and it was determined that S1 and S2 violated Conduct Inimical.

On today’s visit LPA Ramirez met with Administrator Tonya Saunders. Copies of the immediate exclusion letter were delivered in person to Administrator Saunders and S2.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
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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