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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603511
Report Date: 06/23/2022
Date Signed: 06/23/2022 01:27:09 PM

Document Has Been Signed on 06/23/2022 01:27 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:REM CALIFORNIA, LLC - PARK STREETFACILITY NUMBER:
198603511
ADMINISTRATOR:MURRAY, MARSHAFACILITY TYPE:
735
ADDRESS:9559 PARK STREETTELEPHONE:
(310) 935-2811
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 3CENSUS: 1DATE:
06/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator Marsha MurrayTIME COMPLETED:
01:40 PM
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On 6/23/2022 at 11:30 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced case management visit to conduct a health and safety check. LPA met with Administrator Marsha Murray and explained the reason for the visit. Facility is vendorized through Harbor regional Center.

LIS File review revealed no staff is associated to the facility. Administrator stated all staff is associated under old facility name and license and facility received license from CCLD last week. LPM Fernando Fierros spoke to facility Executive Director Tammi Castillo on 5/27/22 regarding facility having problems with guardian. LPA spoke to Executive Director Tammi Castillo and confirmed facility HR having a guardian account but need to get access to newly acquired facilities. Executive Director Tammi Castello stated they have reached out to guardian 2 times in May and once in June. Executive director Tammi Castello will email LPA the LIC 9182 and proof of repeated attempts to associate staff to guardian. Staff file review revealed LIC 9182 for old facility name (Acers California) criminal background and fingerprint clearance.

During today’s visit LPA toured the physical plant of the facility and did not observe any path obstructions or health and safety hazards. LPA observed the food supply and toxins and sharps were locked and inaccessible to clients in care. LPA obtained a copy of the Staff/client roster and all employee driver’s license during the visit.


Immediate civil Penalties may be assessed pending further information. Exit Interview held. A copy of the report was provided to Administrator Marsha Murray.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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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