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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603650
Report Date: 07/14/2023
Date Signed: 07/14/2023 05:06:35 PM

Document Has Been Signed on 07/14/2023 05:06 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:DIGNITY HOME CENTER INC. IIFACILITY NUMBER:
198603650
ADMINISTRATOR:DUROMOLA, ADEBOWALE EVELYNFACILITY TYPE:
735
ADDRESS:211 S LARK ELLEN AVETELEPHONE:
(626) 922-3944
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY: 4CENSUS: 4DATE:
07/14/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Veronica Nosike TIME COMPLETED:
09:30 AM
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On 7/14/2023, Licensing Program Analyst (LPA) Wong conducted a follow-up Pre-Licensing inspection to verify the correction that was indicated during the initial Pre-Licensing visit held on 7/6/2023. LPA met with DSP Veronica Nosike and assisted with today's visit.

During the visit, LPA Wong observed the correction that addressed at the initial visit:
  • All four of the stove top were fixed.


Pre-Licensing deficiency has been resolved. Pre-Licensing is now complete.

An exit interview was conducted and a copy of the report was provided to DSP Veronica Nosike.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2023
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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