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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603634
Report Date: 11/09/2023
Date Signed: 11/09/2023 01:29:50 PM


Document Has Been Signed on 11/09/2023 01:29 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:ANEW DAWN ADULT LIVINGFACILITY NUMBER:
198603634
ADMINISTRATOR:DUFRENNE, PATRIA MARAVILLAFACILITY TYPE:
735
ADDRESS:4340 LOCKWOOD AVETELEPHONE:
(323) 426-9123
CITY:LOS ANGELESSTATE: CAZIP CODE:
90029
CAPACITY:94CENSUS: 45DATE:
11/09/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Patria Dufrene TIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christine Wong generated this Case Management - Deficiencies evaluation report in conjunction with Complaint Control # 28-AS-20231103163613 and made the following observation. While LPA conducted the investigation and reviewed Client#1 (C1) documents, and observed the 30 days eviction notice for Client#1 (C1) which issued on 09/19/23. LPA reviewed the Community Care Licensing (CCL) internal folder and did not receive any 30 days eviction notice for C1. The staff and administrator reported they did fax to Licensing on 09/19/23. LPA reviewed the facility fax confirmation and found out the fax was not going through and it had an error on it.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiencies and issued a citation.

An exit interview was conducted and a copy of the Report and Appeal Rights were provided to Administrator Patria Dufrene.

SUPERVISOR'S NAME: David SicairosTELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023
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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Document Has Been Signed on 11/09/2023 01:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: ANEW DAWN ADULT LIVING
FACILITY NUMBER: 198603634

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/23/2023
Section Cited
CCR
80068.5(e)

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80068.5 Eviction Procedures (e)The licensee shall mail or fax to the Department a copy of the 30-day written notice in accordance with (a) above within five days of giving the notice to the client. The requirement was not met as evidenced by documents reviewed:
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Administrator to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Licensee to submit a faxed or mailed copy of POC by due date.
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While LPA reviewed Client#1 (C1) documents (30 days eviction notice) and found out Community Care Licensing never received the 30 days eviction notice for C1, althoguh the facility did fax it but it did not go through.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023
LIC809 (FAS) - (06/04)
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