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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603661
Report Date: 01/18/2024
Date Signed: 01/18/2024 01:57:01 PM


Document Has Been Signed on 01/18/2024 01:57 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:EXCELLENCE BOARD AND CARE LLCFACILITY NUMBER:
198603661
ADMINISTRATOR:ESPINAL, ALMAFACILITY TYPE:
740
ADDRESS:12551 DOWNEY AVE.TELEPHONE:
(818) 799-7218
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:6CENSUS: 0DATE:
01/18/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Rey John Bertulfo, LicenseeTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Galarza conducted a follow-up Pre-licensing visit to verify corrections. The purpose of the visit was explained to Licensee Rey John Bertulfo and Administrator Alma Espinal. An initial Pre-licensing visit was conducted on 12/22/2023.


The items listed below have been corrected:

1. The exit door lock in the north side yard has been removed.



2. Window screens were installed in the ten (10) windows identified windows that did not have screens.

3. All sliding doors have installed window screens.

4. The storage structure in the rear of the property was cleaned. All discarded personal belongings,


discarded furniture, gardening equipment, gardening tools and grass weed killer were removed and/or
locked in storage.

5. Outdoor surveillance cameras that were observed inoperable were removed.

6. Auditory alarms were installed in all exit doors and windows.

An exit interview was conducted, and a copy of this report has been furnished to applicant Rey John Bertulfo. 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.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024
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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