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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603619
Report Date: 03/26/2024
Date Signed: 04/03/2024 04:36:56 PM

Document Has Been Signed on 04/03/2024 04:36 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:DAJAH'S HOME BFACILITY NUMBER:
198603619
ADMINISTRATOR:ROBERTSON, MILESFACILITY TYPE:
735
ADDRESS:11624 TIGRINA AVETELEPHONE:
(562) 755-7464
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY: 4CENSUS: 0DATE:
03/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jesse Quezada TIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Angelica Rea conducted a required annual inspection. LPA Rea was greeted and allowed entry into the facility by Jesse Quezada and Cynthia Tadeo. There are currently 0 residents living in the facility. Mr. Quezada stated that he is currently working with the regional center and plans to admit residents in the near future.

The physical plant was toured and the following was observed: This facility is located in a residential neighborhood, single story house, with (4) bedrooms, (2) bathrooms, living room, dining area, and kitchen. Bedrooms have the required furniture including bedframes, dressers, lamps and chairs. Beds have the required linen and the linen is in good condition. Passageways and exits are free of obstruction. The front and backyard are well maintained. The resident bathrooms are clean, and showers have non-skid materials. The facility temperature at the time the visit was comfortable. There is sufficient lighting throughout the facility. There are smoke detectors located throughout the facility, tested and operational. Carbon monoxide detector was also observed, tested and operational. The washer/dryer are located in the garage. The medication, and resident and staff files will be kept in a cabinet in the dining area.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided to Mr. Quezada.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2024
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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