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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603648
Report Date: 04/17/2023
Date Signed: 04/17/2023 11:33:33 PM

Document Has Been Signed on 04/17/2023 11:33 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:OMEO ARCADIA LIVINGFACILITY NUMBER:
198603648
ADMINISTRATOR:ZHANG, JINGFANGFACILITY TYPE:
740
ADDRESS:601 SUNSET BLVDTELEPHONE:
(323) 422-8030
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY: 99CENSUS: 0DATE:
04/17/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:TIME COMPLETED:
09:15 AM
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Licensing Program Analyst (LPA) Jose Villalobos attempted to conduct a scheduled pre-licensing visit for the Change of Ownership application. Applicant ZHANG, JINGFANG "Jennifer Lan" was unable to meet with LPA to start the pre-licensing visit; therefore, visit will need to be scheduled and conducted at a later time.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2023
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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