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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603619
Report Date: 02/18/2025
Date Signed: 02/18/2025 02:29:38 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/18/2025 02:29 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:DAJAH'S HOME BFACILITY NUMBER:
198603619
ADMINISTRATOR/
DIRECTOR:		ROBERTSON, MILESFACILITY TYPE:
735
ADDRESS:11624 TIGRINA AVETELEPHONE:
(562) 755-7464
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY: 4CENSUS: 0DATE:
02/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Jeese Quezada, LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Sanjay Vaid conducted a required annual inspection. LPA was greeted and allowed entry into the facility by Jesse Quezada, licensee. There are currently zero (0) residents living in the facility. Mr. Quezada stated that he is currently working with the regional center and planning on admitting residents as soon as regional center approves the clients to the home.

The physical plant was toured, and the following was observed: This facility location is in a residential neighborhood, single story home, 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 water temperature at the time the visit was within 105-120*F, facility temperature is comfortable on today’s visit. 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. Fire extinguisher is located in the kitchen and is fully charged. The washer/dryer are located in the garage. The medication, and resident and staff files will be kept in a secure 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: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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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