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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003847
Report Date: 06/09/2022
Date Signed: 06/09/2022 03:51:40 PM


Document Has Been Signed on 06/09/2022 03:51 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:LG GUEST HOME IIFACILITY NUMBER:
306003847
ADMINISTRATOR:STELLA LADABANFACILITY TYPE:
740
ADDRESS:6700 LASSEN DR.TELEPHONE:
(714) 484-1493
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:6CENSUS: DATE:
06/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:23 PM
MET WITH:Stella LadabanTIME COMPLETED:
03:57 PM
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On today's date, Licensing Program Analyst (LPA) LPA Edward Tapia conducted a Case Management visit with the purpose to drop off PPE requested by Administrator during Annual visit. LPA dropped off hand sanitizer and gloves.

LPA also made Administrator aware that facility phone number needs to be operational at all times. LPA informed Administrator voicemail needs to be cleared. LPA observed Administrator tried to fix phone but Administrator could not get phone to work. Administrator will get a new phone and also provided cell phone number to LPA.

Based on today's observations, there are no citations being cited during today's visit. An exit interview was conducted with Administrator Stella Ladaban, and a copy of this report was provided at exit.

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward TapiaTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022
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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