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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603620
Report Date: 04/25/2023
Date Signed: 06/02/2023 10:48:17 AM

Document Has Been Signed on 06/02/2023 10:48 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:DAJAH'S HOME AFACILITY NUMBER:
198603620
ADMINISTRATOR:GONZALEZ, DIANAFACILITY TYPE:
735
ADDRESS:9937 EMERADO DRIVETELEPHONE:
(562) 536-2935
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY: 4CENSUS: 0DATE:
04/25/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Applicant Jesse QuezadaTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Jose Villalobos conducted an announced visit with Applicant Jesse Quezada. The purpose of the visit was to conduct a subsequent Pre-Licensing visit to observe corrections.

The following Corrections were needed to be completed prior to Licensing clearing the physical plant.
  • Required postings such as: Emergency disaster plan, activities calendar, food menu, clients personal rights

  • Backyard has a gate with no lock that leads to a downhill slope which could be a potential health and safety risk

  • inoperable go kart located in the backyard to be removed

  • telephone line to be operable

On todays visit , LPA observed all the above corrections completed. Physical plant is now cleared

An exit interview was conducted and a copy of this report has been furnished to the Applicants. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2023
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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