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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603519
Report Date: 06/07/2024
Date Signed: 06/07/2024 09:55:47 AM

Document Has Been Signed on 06/07/2024 09:55 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:KALI'S QUALITY HOME, INCFACILITY NUMBER:
198603519
ADMINISTRATOR/
DIRECTOR:		SABILLO, VENERANDAFACILITY TYPE:
735
ADDRESS:18226 ESPITO STTELEPHONE:
(951) 217-2318
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY: 4CENSUS: 2DATE:
06/07/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:27 AM
MET WITH:Administartor SabilloTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted a collateral visit to interview Client #1 (C1) in regard to C1’s prior facility placement. LPA Ramirez was greeted by Direct Support Staff (DSP) Susan Ochoada. Administrator Veneranda Sabillo arrived shortly after.

At 9:35 am, LPA Ramirez interviewed C1. Exit interview conducted with Administrator Sabillo. A copy of this report was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2024
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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