<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000543
Report Date: 04/28/2022
Date Signed: 04/28/2022 03:10:37 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/28/2022 03:10 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:HELLEN LOVING HOME CAREFACILITY NUMBER:
306000543
ADMINISTRATOR:ELENA GHERMANFACILITY TYPE:
740
ADDRESS:10592 BELL STREETTELEPHONE:
(714) 827-3920
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY:6CENSUS: 0DATE:
04/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Cornel GhermanTIME COMPLETED:
03:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs ) Edward Tapia and Michelle Reed made an unannounced required annual inspection to this facility. LPAs met with Licensee's husband Cornel Gherman and stated the purpose of this visit. Licensee Elena Gherman was contacted via telephone and stated that she did not have any residents and she would not be available to come to the facility. LPAs toured the facility and the following was observed:

The facility is a single level structure at the back of the property. There are 3 bedrooms and 2 bathrooms. The bedrooms were being used as storage at this time and there were no residents present.

Mrs. Gherman was reminded that even though she has decided not to operate annual inspections will still need to occur and her fees must be paid. When she does begin to operate, she needs to notify the Department before accepting any new residents. Licensee is further reminded that all individuals living and working on the property, including the front home will need to be fingerprint cleared.

No Deficiencies noted at this time. LPA Tapia conducted an exit interview with Cornel Gherman and a copy of this report was given.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward TapiaTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1