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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603520
Report Date: 07/25/2024
Date Signed: 07/25/2024 09:34:13 AM

Document Has Been Signed on 07/25/2024 09:34 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:JOURNEY TOGETHER CARE HOMEFACILITY NUMBER:
198603520
ADMINISTRATOR/
DIRECTOR:		ARGUELLES, NELSONFACILITY TYPE:
735
ADDRESS:14627 LA PLUMA DRTELEPHONE:
(562) 217-7937
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY: 4CENSUS: 4DATE:
07/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator Nelson Arguelles TIME VISIT/
INSPECTION COMPLETED:
09:40 AM
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced case management visit to the facility. The purpose of today’s visit was to serve the Order to Licensee of Immediate Exclusion from Facility for Staff #1 (S1). An investigation by the California Department of Social Services was conducted and it was determined that S1 violated California Code of Regulations Title 22 for Personal Rights.

On today's visit LPA met with Administrator Nelson Arguelles and explained the reason for the visit. Administrator was provided with copies of the Order to Licensee of Immediate Exclusion and Order to Individual for Immediate Exclusion letters and Government Code 11522.

Exit interview held and a copy of the report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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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