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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300612929
Report Date: 05/12/2022
Date Signed: 05/12/2022 05:10:50 PM


Document Has Been Signed on 05/12/2022 05:10 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:HARTFORD HOME CAREFACILITY NUMBER:
300612929
ADMINISTRATOR:DINO ASUNCIONFACILITY TYPE:
740
ADDRESS:2424 HARTFORD AVETELEPHONE:
(562) 349-4217
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:6CENSUS: 0DATE:
05/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Dino Asuncion, Licensee/AdministratorTIME COMPLETED:
05:20 PM
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This unannounced site visit was made by LPA, Kathrina Chin for the purpose of a case management visit. LPA met with Dino Asunsion, Licensee/Adminisrator and Arnel Dino, Manager. LPA toured the facility and all residents have been relocated. There are no residents left at the facility. Dino Asuncion has sold the facility and wants to close the facility effective May 13, 2022. She has provided a letter of her intent to close by tomorrow, May 13, 2022. She also handed the two copies of her license.

An exit interview was conducted, and a copy of this report was given to Dino Asuncion, Licensee/Administrator.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022
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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