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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603646
Report Date: 05/01/2023
Date Signed: 05/01/2023 02:40:45 PM

Document Has Been Signed on 05/01/2023 02:40 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, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:INTEGRATED LIFE LLCFACILITY NUMBER:
198603646
ADMINISTRATOR:DE LEON, CORINAFACILITY TYPE:
775
ADDRESS:10329 ARTESIA BOULEVARDTELEPHONE:
(562) 202-9942
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 30CENSUS: 0DATE:
05/01/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Corina De Leon, Administrator/Applicant
Catherine Bennage, Manager/Director		TIME COMPLETED:
02:25 PM
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Component II completion: Successful

Facility Type: Adult Day Program (ADP)
Application Type: Initial
Capacity: 30
Census (if any clients in care): none
COMP II Participants: Corina De Leon, Administrator
Catherine Bennage, Manager
Interview Method: Telephone interview

On May 1, 2023, Monday at 1:45 PM Administrator and Manager participated in COMP II. Identification of the Administrator and Manager was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Administrator and Manager confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22.

During COMP II, CAB analyst confirmed Administrator and Manager's understanding of following areas:
1. Facility Operation: License type, client/resident populations, and program
2. Admission Policies
3. Staffing eRquirements & Training
4. Restrictive/Prohibited Health Conditions
5. General Provisions
6. Emergency Preparedness
7. Complaints & Reporting
8. Pre-licensing Readiness

Exit interview conducted with Administrator and Mangers. Sent copy of report pdf via email. Instructed sign report and reuturn back to CAB by end of business day today.
SUPERVISORS NAME: Darla Neeley
LICENSING EVALUATOR NAME: Celia Phomphachanh
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2023
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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