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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003441
Report Date: 02/05/2021
Date Signed: 02/05/2021 02:42:32 PM

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:WHITTIER COTTAGEFACILITY NUMBER:
306003441
ADMINISTRATOR:BOHANAN-TRAZO, VILMAFACILITY TYPE:
740
ADDRESS:710 RYE AVENUETELEPHONE:
(714) 449-0209
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:6CENSUS: 5DATE:
02/05/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator (AD) James TrazoTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Sean Haddad conducted an unannounced Case Management tele-visit for the purpose of a health and safety check via FaceTime due to COVID-19 Pandemic and precautionary measures. LPA explained the reason for today's visit and conducted a virtual tour of the inside of the facility, common areas, and kitchen along with Administrator (AD) James Trazo and observed the following:

LPA observed there were 2 staff present, all wearing PPE. LPA observed 4 residents present, all in their rooms. LPA interviewed 3 residents, confirmed they were doing well, and observed no health and safety issues. LPA observed the electricity and water were running and the facility had soap and paper towels. LPA inspected common areas and kitchen, observed they were clean and organized, and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. LPA observed hallways and walkways were free of obstruction.

There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 of the California Code of Regulations.

An exit interview was conducted with AD. This report will be emailed and an electronic email read receipt confirms receipt of the report. AD agrees to sign the report and email it back to LPA.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 355-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021
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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